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We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.<\/strong> <\/p>\nBack to Healio<\/button><\/p>\n<\/div>\n<\/div><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\nKey takeaways:<\/h2>\n\nIf surgery is unavoidable, ophthalmologists should try to perform the procedure in the second trimester.<\/li>\n Case reports support trabeculectomy, tube shunt procedures and cyclophotocoagulation as options.<\/li>\n<\/ul>\nWhen considering performing glaucoma surgery in patients who are pregnant, ophthalmologists should weigh factors such as timing of surgery and type of anesthesia while prioritizing a team approach.<\/p>\n
While data covering the impact of glaucoma surgery on pregnancy are limited, Sunita Radhakrishnan, MD,<\/b> said that the risk profile is different compared with common non-obstetric surgeries.<\/p>\n
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\u201cEye surgery has a relatively short duration,\u201d she said in a presentation at the American Glaucoma Society meeting. \u201cIt can be performed under local anesthesia, and there is very minimal postoperative pain, which is important because postop pain can trigger pre-term labor, so we want to avoid that. Also, our patients are generally in good systemic health.\u201d<\/p>\n
However, risks still exist, with the AGS and the Canadian Glaucoma Society recommending that surgery should not be performed until all available options for IOP lowering are pursued and that patients should be monitored for higher IOP for the duration of the pregnancy. Therefore, putting a plan of action in place during the pre-conception stage whenever possible is important, according to Radhakrishnan. <\/p>\n
\u201cWe can also use [selective laser trabeculoplasty] in the pre-conception phase as a medication replacement or reduction strategy,\u201d she said. \u201cDuring pregnancy, if the pressure increases, then we can escalate medical therapy after consultation with the obstetrician. … If feasible, SLT can be used as an adjunct treatment to medications.\u201d<\/p>\n
If surgery is unavoidable, Radhakrishnan recommended that ophthalmologists aim to perform the procedure during the second trimester due to lower risks for spontaneous abortion and pre-term labor compared with the first trimester and the third trimester, respectively. <\/p>\n
\u201cIf medically necessary, then intervene regardless of the trimester,\u201d she said.<\/p>\n
While no single procedure is perfect, case reports support trabeculectomy, tube shunt procedures and cyclophotocoagulation as options. Radhakrishnan said she could not find any case reports to support angle-based minimally invasive glaucoma surgery, but it can be considered as a reasonable option because it has shorter surgical and recovery times as well as a positive safety profile compared with trabeculectomy and tube shunt procedures. Ophthalmologists should avoid using antimetabolites, which are contraindicated for patients who are pregnant.<\/p>\n
\u201cIn terms of anesthesia, we can do a great job typically with a combination of topical, subconjunctival and sub-Tenon approaches,\u201d Radhakrishnan said. <\/p>\n
Lidocaine, a category B anesthesia, is commonly used for eye surgery in patients who are pregnant, but bupivacaine should be avoided because it is associated with fetal bradycardia. <\/p>\n
While operating, Radhakrishnan recommended using a wedge pillow to create a 30\u00b0 lateral tilt and making sure the patient\u2019s abdomen is turned to the left to reduce risk for aortocaval compression.<\/p>\n
After surgery, ophthalmologists are typically able to use topical steroids such as prednisolone and dexamethasone despite being marked as category C for patients who are pregnant.<\/p>\n
\u201cThe use of topical meds seems to have very little downside,\u201d Radhakrishnan said.<\/p>\n
While patients with glaucoma generally receive standard obstetric care during labor, if delivery is anticipated in the immediate period after trabeculectomy or tube shunt procedures, a cesarean section may need to be considered, according to Radhakrishnan.<\/p>\n
\u201cThese patients require a team approach involving the OB or the maternal fetal medicine specialist, the anesthesiologist and the neonatologist,\u201d she said.<\/p>\n
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Sources\/Disclosures<\/h3>\n Source: <\/h2>\n Radhakrishnan S. Glaucoma in pregnancy: Is surgery the safest way? Presented at: American Glaucoma Society meeting; Feb. 19-22, 2026; Rancho Mirage, California (hybrid).<\/p>\n
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