A Systematic Review on the Management of Glaucoma During Pregnancy

Glaucoma during pregnancy presents a multifaceted clinical challenge, requiring a delicate balance between effective intraocular pressure (IOP) control and fetal safety. Background: This review examines the physiological ocular changes that occur during pregnancy and their implications for glaucoma progression and management. Methods: It synthesizes current evidence on IOP fluctuations, disease progression risks, and the safety profiles of pharmacologic, laser, and surgical interventions. Studies were included if they met the following criteria: (1) involved pregnant women diagnosed with glaucoma or ocular hypertension; (2) investigated any aspect of glaucoma management during pregnancy, including pharmacological, laser-based, or surgical interventions; and (3) reported outcomes related to intraocular pressure control, optic nerve assessment, or visual field evaluation. Studies that focused exclusively on other ocular complications of pregnancy were excluded. Particular attention is given to emerging trends in minimally invasive glaucoma surgeries (MIGS), diagnostic innovations, and pharmacotherapies tailored to the gestational period. Results: From an initial pool of 257 records identified through database searches, 184 studies remained after the removal of duplicates. Following title and abstract screening, 73 full-text articles were assessed for eligibility. Ultimately, 54 studies met all inclusion criteria and were included in the final review. Pregnancy, however, introduces diagnostic challenges related to intraocular pressure (IOP) assessment, variability in individual responses, and the potential for unexpected increases in IOP. The extent of IOP reduction during pregnancy may be influenced by both physiological and demographic factors, including age, parity, systemic blood pressure, and central corneal thickness (CCT), all of which can modulate the magnitude of IOP change. For instance, multiparous women often exhibit more pronounced IOP reductions compared to primigravidae. Beta-blockers remain among the most frequently prescribed agents during pregnancy; however, punctal occlusion is recommended to minimize systemic absorption. Alternative therapeutic options, such as selective laser trabeculoplasty (SLT) and minimally invasive glaucoma surgery (MIGS), may be considered based on disease severity and the gestational stage. Conclusions. The findings advocate for a patient-centered approach that integrates evidence-based strategies to preserve maternal vision while ensuring fetal well-being. Ongoing research and inter-disciplinary collaboration will be essential in developing new approaches while safeguarding both maternal and fetal health.