Objective:

To discuss the considerations and guidelines for performing glaucoma surgery in pregnant patients, emphasizing safety and risk management.

Approach:

Key Findings:

• Nonobstetric surgery occurs in up to 2% of pregnancies, with maternal outcomes comparable to nonpregnant patients.
• Risks to the fetus during surgery are unclear and may stem from the surgery or the underlying condition.
• Elective procedures should be postponed until after delivery, while medically necessary surgeries should not be delayed.
• MIGS procedures may be preferable due to shorter surgical times and faster recovery, though data on their use during pregnancy is lacking.

Interpretation:

Surgery for glaucoma during pregnancy should be approached cautiously, with a preference for non-surgical management when possible, and careful planning and coordination among medical teams emphasized.

Limitations:

• Lack of established guidelines and limited evidence from animal studies and case reports.
• No published data on the use of MIGS during pregnancy, impacting clinical decision-making.

Conclusion:

Surgery is not the safest first option during pregnancy but can be performed with appropriate modifications and multidisciplinary coordination when necessary, stressing the importance of careful planning.

Sources:

• American Glaucoma Society
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