Eyeworld

90 | EYEWORLD | MARCH 2020 G RESEARCH HIGHLIGHT UCOMA by Maxine Lipner Senior Contributing Writer M anagement of glaucoma in patients who are pregnant can present ophthalmologists with new considerations. Investigators in a recent study 1 determined that IOP can actually be lower in pregnant women, according to Barbara Wirostko, MD. Challenges include that some medications could have adverse effects on the fetus and newborns. Evaluating issues Management of this population of patients is particularly difficult due to their hemodynamic status and concerns about how any medications used to treat glaucoma may impact the fetus or even the newborn after birth via breast milk, Dr. Wirostko said. For example, when it came to the use of beta blockers, investigators found two papers 2,3 showing that breast milk concen- tration was 3 to 6 times higher than plasma of a lactating female. It can cause bradycardia in newborns, Dr. Wirostko reported. Brimonidine should also be used with caution postpartum 4,5 because "it has significant CNS depression, apnea, and hypotensive effects on young individuals," Dr. Wirostko said, adding that it's eye-opening how much of the drug could be concentrated in the breast milk. Investigators also considered the fact that prostaglandins, although not those used to treat glaucoma, are used to induce labor. This is something that Dr. Wirostko keeps in mind. "I think it behooves us not to use prostaglandins in the last trimester, if we can avoid them," she said. Not much is known about various topical vascular-modulating drugs and their effect on smooth muscles. "We don't know how they re- act and interact with blood pressure and blood volume in pregnant women and uterine smooth muscle," Dr. Wirostko said. The fact that the study found IOP was lower in pregnant women was not surprising to Dr. Wirostko. "One of the things that changes for women when they're pregnant is the blood volume expansion, but also the vasodilation with there being an inverse relationship with Controlling glaucoma in pregnant patients About the doctor Barbara Wirostko, MD Adjunct professor of ophthalmology and biomedical engineering University of Utah Moran Eye Center Salt Lake City, Utah References 1. Mathew S, et al. Management of glaucoma in pregnancy. J Glaucoma. 2019;28:937–944. 2. Lustgarten JS, Podos SM. Topical timolol and the nursing mother. Arch Ophthalmol. 1983;101:1381–2. 3. Morselli PL, et al. Placental transfer and perinatal pharma- cokinetics of betaxolol. Eur J Clin Pharmacol. 1990;38:477–83. 4. Fudemberg SJ, et al. Efficacy, safety, and current applications of brimonidine. Expert Opin Drug Saf. 2008;7:795–9. 5. Coleman AL, et al. Medical therapy in pregnancy. J Glauco- ma. 2005;14:414–6. Relevant disclosures Wirostko: None Contact Wirostko: barbara.wirostko@hsc.utah.edu continued on page 92

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