Tratamiento del glaucoma en el embarazo y lactancia: revisión de la literatura

Vanessa Lopez-Torres; Omar Fernando Salamanca-Libreros

doi:10.17533/udea.iatreia.186

Autores/as

Vanessa Lopez-Torres Universidad del Valle, Cali, Colombia
Omar Fernando Salamanca-Libreros Universidad del Valle. Cali, Colombia https://orcid.org/0000-0001-8810-5736

DOI:

https://doi.org/10.17533/udea.iatreia.186

Palabras clave:

Embarazo, Glaucoma, Lactancia , Presión intraocular

Resumen

Introducción: la presión intraocular (PIO) en el embarazo disminuye levemente hacia la semana 18 de gestación. Sin embargo, en mujeres embarazadas con glaucoma o con hipertensión ocular la PIO puede ser variable y no necesariamente se reducirá, por lo que algunas pacientes requieren de un tratamiento que conlleva potenciales riesgos para la embarazada y el feto.

Objetivo: describir los cambios fisiopatológicos oculares relevantes, las opciones de manejo y los posibles efectos adversos del tratamiento durante el embarazo y la lactancia en pacientes con glaucoma asociado.

Materiales y métodos: se realizó una revisión de la literatura desde el año 2001 al 2021, considerando los términos MeSH correspondientes para glaucoma, embarazo, lactancia y presión intraocular. Se extrajo y sintetizó la información de forma estructurada.

Resultados: cada vez es más frecuente la identificación de pacientes en embarazo con glaucoma. Esta condición se puede tratar con medicamentos tópicos, la mayoría de los cuales, sin embargo, son categoría C. El tratamiento con trabeculoplastia selectiva con láser parece ser una opción segura, pero la evidencia es limitada. La cirugía para glaucoma es una posibilidad en caso de pobre control de la PIO y deterioro de la función visual, mientras que el uso de antimetabolitos está completamente contraindicado en este grupo de pacientes. Durante la lactancia es necesario ajustar los medicamentos tópicos, considerando las condiciones del neonato.

Conclusión: el abordaje del glaucoma en la paciente embarazada requiere un preciso balance entre el control de la PIO para prevenir el daño visual en la mujer o el lactante y la prevención de efectos adversos en el feto o el recién nacido.

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Biografía del autor/a

Vanessa Lopez-Torres, Universidad del Valle, Cali, Colombia

MD. Oftalmóloga Universidad del Valle, Fellowship de córnea, segmento anterior y cirugía refractiva, Clínica FOSCAL, Floridablanca, Colombia.

Omar Fernando Salamanca-Libreros, Universidad del Valle. Cali, Colombia

MD. Oftalmólogo, Especialista en Glaucoma, Servicio de Oftalmología y Grupo de Investigación Visión y Salud Ocular VISOC, Universidad del Valle, Cali, Colombia. Orbis International. New York, USA.

Citas

(1) Weinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: A review. JAMA [Internet]. 2014;311(18):1901–11. DOI 10.1001/jama.2014.3192.

(2) Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: A systematic review and meta-analysis. Ophthalmology [Internet]. 2014;121(11):2081–90. DOI 10.1016/j.ophtha.2014.05.013.

(3) Rivera CE, Cantor E, Castillo A, Martinez A, Newball L, Rueda JC, et al. Prevalence of Primary Open Angle Glaucoma among Patients with Diagnosis of Systemic Hypertension and Diabetes Mellitus: The Colombian Glaucoma Study. Open J Ophthalmol [Internet]. 2020;10(02):99–114. DOI 10.4236/ojoph.2020.102012.

(4) Acott TS, Vranka JA, Keller KE, Raghunathan VK, Kelley MJ. Normal and glaucomatous outflow regulation. Prog Retin Eye Res [Internet]. 2021;82:100897. DOI 10.1016/j.preteyeres.2020.100897.

(5) Lusthaus J, Goldberg I. Current management of glaucoma. Med J Aust [Internet]. 2019;210(4):180–7. DOI 10.5694/mja2.50020.

(6) Nabukera S, Wingate MS, Alexander GR, Salihu HM. First-time births among women 30 years and older in the United States: Patterns and risk of adverse outcomes. J Reprod Med Obstet Gynecol [Internet]. 2006;51(9):676–82.

(7) Belkin A, Chen T, DeOliveria AR, Johnson SM, Ramulu PY, Buys YM. A Practical Guide to the Pregnant and Breastfeeding Patient with Glaucoma. Ophthalmol Glaucoma [Internet]. 2020;3(2):79–89. DOI 10.1016/j.ogla.2019.12.004.

(8) Razeghinejad MR, Tania Tai TY, Fudemberg SJ, Katz LJ. Pregnancy and Glaucoma. Surv Ophthalmol [Internet]. 2011;56(4):324–35. DOI 10.1016/j.survophthal.2010.11.008.

(9) Razeghinejad MR, Masoumpour M, Eghbal MH, Myers JS, Moster MR. Glaucoma surgery in pregnancy: A case series and literature review. Iran J Med Sci [Internet]. 2016;41(5):437–45.

(10) Sen E, Onaran Y, Nalcacioglu-Yuksekkaya P, Elgin U, Ozturk F. Corneal biomechanical parameters during pregnancy. Eur J Ophthalmol [Internet]. 2013;24(3):314–9. DOI 10.5301/ejo.5000378.

(11) Wang C, Li AL, Pang Y, Lei YQ, Yu L. Changes in intraocular pressure and central corneal thickness during pregnancy: A systematic review and Meta-analysis. Int J Ophthalmol [Internet]. 2017;10(10):1573–9. DOI 10.18240/ijo.2017.10.15.

(12) Naderan M, Jahanrad A. Anterior, posterior and biomechanical parameters of cornea during pregnancy in healthy eyes: A cohort study. Br J Ophthalmol [Internet]. 2018;102(3):309–12. DOI 10.1136/bjophthalmol-2017-310247.

(13) Ebeigbe JA, Ebeigbe PN, Ighoroje AD. Intraocular pressure in pregnant and non-pregnant Nigerian women. Afr J Reprod Health [Internet]. 2011;15(4):20–3.

(14) Ataş M, Duru N, Ulusoy DM, Altinkaynak H, Duru Z, Açmaz G, et al. Evaluation of anterior segment parameters during and after pregnancy. Contact Lens Anterior Eye [Internet]. 2014;37(6):447–50. DOI 10.1016/j.clae.2014.07.013.

(15) Kanner EM, Netland PA. Pregnancy and Pediatric Patients. En: Netland PA, editor. Glaucoma Medical Therapy: Principles and Management. 2nd ed. New York: American Academy of Ophthalmology; 2008. p. 233–41.

(16) Dewundara SS, Wiggs JL, Sullivan DA, Pasquale LR. Is estrogen a therapeutic target for glaucoma? Semin Ophthalmol [Internet]. 2016;31(1–2):140–6. DOI 10.3109/08820538.2015.1114845.

(17) Spoerl E, Zubaty V, Raiskup-Wolf F, Pillunat LE. Oestrogen-induced changes in biomechanics in the cornea as a possible reason for keratectasia. Br J Ophthalmol [Internet]. 2007;91(11):1547–50. DOI 10.1136/bjo.2007.124388.

(18) Efe YK, Ugurbas SC, Alpay A, Ugurbas SH. The course of corneal and intraocular pressure changes during pregnancy. Can J Ophthalmol [Internet]. 2012;47(2):150–4. DOI 10.1016/j.jcjo.2012.01.004.

(19) Goldich Y, Cooper M, Barkana Y, Tovbin J, Ovadia KL, Avni I, et al. Ocular anterior segment changes in pregnancy. J Cataract Refract Surg [Internet]. 2014;40(11):1868–71. DOI 10.1016/j.jcrs.2014.02.042.

(20) Mendez-Hernandez C, Garcia-Feijoo J, Saenz-Frances F, Santos-Bueso E, Martinez-de-la-Casa JM, Megias AV, et al. Topical intraocular pressure therapy effects on pregnancy. Clin Ophthalmol [Internet]. 2012;6:1629–32. DOI 10.2147/OPTH.S36712.

(21) Brauner S, Chen T, Hutchinson T, Chang M, Pasquale L, Grosskreutz C. The Course of Glaucoma During Pregnancy. Arch Ophthalmol [Internet]. 2006;124:1089–94. DOI 10.1001/archopht.124.8.1089.

(22) Gedde SJ, Vinod K, Wright MM, Muir KW, Lind JT, Chen PP, et al. Primary Open-Angle Glaucoma Preferred Practice Pattern® [Internet]. American Academy of Ophthalmology. 2020. p. 101–2. Disponible en: https://www.aao.org/preferred-practice-pattern/primary-open-angle-glaucoma-ppp

(23) American Academy of Ophthalmology. Ocular pharmacotherapeutics. En: Fundamentals and principles of ophthalmology Basic and Clinical Science Course. San Francisco CA: American Academy of Ophthalmology; 2017. p. 321–2.

(24) Freddo TF, Gong H. Anatomy of the Ciliary Body and Outflow Pathways. En: Tasman W, Jaeger E. Duane’s Clinical Ophthalmology. 13th ed. Lippincott Williams and Wilkins; 2013. p. 1–18.

(25) Arango S, Gutiérrez LF. Glaucoma. En: Arango K, Mejía LF, Abad JC. Fundamentos de cirugía: Oftalmología. 2a ed. Medellín: Corporación para investigaciones biológicas; 2013. p. 275.

(26) Jindal A, Fudemberg S. Primary Open ‐ Angle Glaucoma. En: Tasman W, Jaeger E. Duane’s Clinical Ophthalmology. 13a ed. Lippincott Williams and Wilkins; 2013. p. 1–53.

(27) Kazemi A, McLaren JW, Kopczynski CC, Heah TG, Novack GD, Sit AJ. The effects of netarsudil ophthalmic solution on aqueous humor dynamics in a randomized study in humans. J Ocul Pharmacol Ther [Internet]. 2018;34(5):380–6. DOI 10.1089/jop.2017.0138.

(28) Garnock-Jones KP. Ripasudil: First global approval. Drugs [Internet]. 2014;74(18):2211–5. DOI 10.1007/s40265-014-0333-2.

(29) Isobe T, Mizuno K, Kaneko Y, Ohta M, Koide T, Tanabe S. Effects of K-115, a Rho-kinase inhibitor, on aqueous humor dynamics in rabbits. Curr Eye Res [Internet]. 2014;39(8):813–22. DOI 10.3109/02713683.2013.874444.

(30) Nakagawa H, Koizumi N, Okumura N, Suganami H, Kinoshita S. Morphological changes of human corneal endothelial cells after rho-associated kinase inhibitor eye drop (ripasudil) administration: A prospective open-label clinical study. PLoS One [Internet]. 2015;10(9):1–15. DOI 10.1371/journal.pone.0136802.

(31) Ho JD, Hu CC, Lin HC. Antiglaucoma medications during pregnancy and the risk of low birth weight: A population-based study. Br J Ophthalmol [Internet]. 2009;93(10):1283–6. DOI 10.1136/bjo.2008.157123.

(32) Giaconi J, Law S, Caprioli J. Primary Angle-Closure Glaucoma. En: Tasman W, Jaeger E, editores. Duane’s Clinical Ophthalmology. 13th ed. Lippincott Williams and Wilkins; 2013. p. 1–67.

(33) Kumari R, Chandra B, Onkar A, Ambasta A, Kumari A. Management of glaucoma in pregnancy balancing safety with efficacy. Ther Adv Ophthalmol [Internet]. 2021;13:1–14. DOI 10.1177/25158414211022876.

(34) Ozawa H, Azuma E, Shindo K, Higashigawa M, Mukouhara R, Komada Y. Transient renal tubular acidosis in a neonate following transplacental acetazolamide. Eur J Pediatr [Internet]. 2001;160(5):321–2. DOI 10.1007/pl00008441.

(35) Lee AG, Pless M, Falardeau J, Capozzoli T, Wall M, Kardon RH. The use of acetazolamide in idiopathic intracranial hypertension during pregnancy. Am J Ophthalmol [Internet]. 2005;139(5):855–9. DOI 10.1016/j.ajo.2004.12.091.

(36) Stamper RL, Wigginton SA, Higginbotham EJ. Primary Drug Treatment for Glaucoma: Beta-Blockers Versus Other Medications. Surv Ophthalmol [Internet]. 2002;47(1):63–73. DOI 10.1016/s0039-6257(01)00286-7.

(37) Sharif NA. Synthetic FP-prostaglandin-induced contraction of rat uterus smooth muscle in vitro. Prostaglandins Leukot Essent Fat Acids [Internet]. 2008;78(3):199–207. DOI 10.1016/j.plefa.2008.01.005.

(38) De Santis M, Lucchese A, Carducci B, Cavaliere AF, De Santis L, Merola A, et al. Latanoprost exposure in pregnancy. Am J Ophthalmol [Internet]. 2004;138(2):305–6. DOI 10.1016/j.ajo.2004.03.002.

(39) Bausch & Lomb. VYZULTA (latanoprostene bunod ophthalmic solution) 0.024% [Internet]. US Food and Drug Administration. 2017. p. 1–8. Disponible en: https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/207795Orig1s000lbl.pdf

(40) Fudemberg SJ, Batiste C, Katz LJ. Efficacy, safety, and current applications of brimonidine. Expert Opin Drug Saf [Internet]. 2008;7(6):795–9. DOI 10.1517/17425250802457609.

(41) De Benedetti G, Giraldo MJP, Alió J. El dilema del glaucoma durante el embarazo: ¿debe o no tratarse? Rev Mex Oftalmol [Internet]. 2011;85(2):85–92. Disponible en: https://www.elsevier.es/es-revista-revista-mexicana-oftalmologia-321-articulo-el-dilema-del-glaucoma-durante-X0187451911238707#:~:text=Sin%20embargo%2C%20su%20suministro%20sist%C3%A9mico,su%20uso%20durante%20el%20embarazo.

(42) Kowa Company LTD. Glanatec ophthalmic solution 0.4% [Internet]. 2020. Disponible en: http://quest3plus.bpfk.gov.my/front-end/attachment/66/pharma/519766/519766_20200624_084100_.pdf

(43) Omori Y, Endo T, Hara Y, Nishiyama M, Midgley I, Smart C, et al. Absorption, distribution and excretion of 14C pilocarpine following oral administration to rats. Arzheimittel-forschung [Internet]. 2004;54(3):171–8. DOI 10.1055/s-0031-1296955.

(44) Maris PJG, Mandal AK, Netland PA. Medical therapy of pediatric glaucoma and glaucoma in pregnancy. Ophthalmol Clin North Am [Internet]. 2005;18(3):461–8. DOI 10.1016/j.ohc.2005.05.006.

(45) Farkouh A, Frigo P, Czejka M. Systemic side effects of eye drops: A pharmacokinetic perspective. Clin Ophthalmol [Internet]. 2016;10:2433–41. DOI 10.2147/OPTH.S118409.

(46) Moroi S, Lichter P. Farmacología ocular. En: Hardman J, Limbird L. Goodman & Gilman Las bases farmacológicas de la terapéutica. 10th ed. Nashville, Tennessee: Mc Graw Hill; 2003. p. 1850–1.

(47) Wilkinson G. Farmacocinética. En: Hardman J, Limbird L. Goodman & Gilman Las bases farmacológicas de la terapéutica. 10th ed. Nashville, Tennessee: Mc Graw Hill; 2003. p. 11.

(48) Molina D, Camacho R, Domínguez A, Vences A. Modulación de la expresión de enzimas del citocromo P450 hepáticas durante las etapas fetal y pediátrica. Rev Educ Bioquímica [Internet]. 2012;31(2):60–71.

(49) Ramulu BPY, Salim S. An approach to glaucoma treatment in pregnant and lactating women. Glaucoma Today. 2012 May-Jun:49–52.

(50) Hotham N, Hotham E. Drugs in breastfeeding. Aust Prescr [Internet]. 2015;38(5):156–9. DOI 10.18773/austprescr.2015.056.

(51) Madadi P, Koren G, Campbell RJ, Trope GE, Oertel R., Freeman DJ. Timolol concentrations in breast milk of a woman treated for glaucoma: Calculation of neonatal exposure. J Glaucoma [Internet]. 2008;17(6):511. DOI 10.1097/IJG.0b013e31815c3a5b.

(52) American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics [Internet]. 2001;108(3):776-89. DOI 10.1542/peds.108.3.776.

(53) Korte JM, Kaila T, Saari KM. Systemic bioavailability and cardiopulmonary effects of 0.5% timolol eyedrops. Graefe’s Arch Clin Exp Ophthalmol [Internet]. 2002;240(6):430–5. DOI 10.1007/s00417-002-0462-2.

(54) Ibrahim A, Hussain N. Brief report: Metabolic acidosis in newborn infants following maternal use of acetazolamide during pregnancy. J Neonatal Perinatal Med [Internet]. 2020;13(3):419–25. DOI 10.3233/NPM-190333.

(55) Sachs HC. The transfer of drugs and therapeutics into human breast milk: An update on selected topics. Pediatrics [Internet]. 2013;132(3). DOI 10.1542/peds.2013-1985.

(56) Coppens G, Stalmans I, Zeyen T. Glaucoma medication during pregnancy and nursing. Bull Soc Belge Ophtalmol [Internet]. 2010;(314):33–6.

(57) Thomas R, Parikh R, Sood D, Vijaya L, Sekhar GC, Sood NN, et al. Efficacy and safety of latanoprost for glaucoma treatment: A three-month multicentric study in India. Indian J Ophthalmol [Internet]. 2005;53(1):23–30. DOI 10.4103/0301-4738.15281.

(58) Razeghinejad MR. Glaucoma medications in pregnancy. Oman J Ophthalmol [Internet]. 2018;11(3):195–9. DOI 10.4103/ojo.OJO_212_2017.

(59) Strelow B, Fleischman D. Glaucoma in pregnancy: An update. Curr Opin Ophthalmol [Internet]. 2020;31(2):114–22. DOI 10.1097/ICU.0000000000000641.

(60) Wilson FM, Blomquist PH. Common ocular medications. En: Practical ophthalmology: A manual for beginning residents. 6th ed. San Francisco CA: American Academy of Ophthalmology; 2009. p. 300.

(61) Berlin RJ, Lee UT, Samples JR, Rich LF, Tang-Liu DDS, Sing KA, et al. Opthalmic drops causing coma in an infant. J Pediatr [Internet]. 2001;138(3):441–3. DOI 10.1067/mpd.2001.111319.

(62) Stayer K, Kane A. Topical apraclonidine toxicity in a 4-month-old infant. Toxicol Commun [Internet]. 2018;2(1):105–6. DOI 10.1080/24734306.2018.1544189.

(63) Wright TM, Freedman SF. Exposure to topical apraclonidine in children with glaucoma. J Glaucoma [Internet]. 2009;18(5):395–8. DOI 10.1097/IJG.0b013e31818624e5.

(64) American Academy of Ophthalmology. Basic and Clinical Science Course: Glaucoma. San Francisco CA; 2017.

(65) Johnson SM, Martinez M, Freedman S. Clinical challenges: Management of Glaucoma in Pregnancy and Lactation. Surv Ophthalmol [Internet]. 2001;45(5). DOI 10.1016/s0039-6257(00)00209-5.

(66) Park M, Moon J. Selective laser trabeculoplasty in fertile women with open angle glaucoma or ocular hypertension. J Korean Ophthalmol Soc [Internet]. 2007;48(11):1494–9. DOI 10.3341/jkos.2007.48.11.1494.

(67) Drake SC, Vajaranant TS. Evidence-Based Approaches to Glaucoma Management During Pregnancy and Lactation. Curr Ophthalmol Rep [Internet]. 2016;4(4):198–205. DOI 10.1007/s40135-016-0112-1.

(68) Wertheim M, Broadway DC. Cyclodiode laser therapy to control intraocular pressure during pregnancy. Br J Ophthalmol [Internet]. 2002;86(11):1318–9. DOI 10.1136/bjo.86.11.1318.

(69) Romá Sánchez E, García Pellicer J, Poveda Andrés J, Ferrer Albiach E. Medicamentos y embarazo: informes de evaluación de teratogenia en el primer trimestre del embarazo [Internet]. España: Generalitat Valenciana; 2007. Disponible en: htttps://www.smhstar.org/panel/uploads/0c9af1_120319_Medicamentos_y_embarazo_dgsp.pdf

(70) Banad N, Choudhari N, Dikshit S, Garudadri C, Senthil S. Trabeculectomy in pregnancy: Case studies and literature review. Indian J Ophthalmol [Internet]. 2020;68(3):420–6. DOI 10.4103/ijo.IJO_638_19.

(71) Nejdlova M, Johnson T. Anaesthesia for non-obstetric procedures during pregnancy. Contin Educ Anaesthesia Crit Care Pain [Internet]. 2012;12(4):203–6. DOI 10.1093/bjaceaccp/mks022.

(72) Vaideanu D, Fraser S. Glaucoma management in pregnancy: A questionnaire survey. Eye [Internet]. 2007;21(3):341–3. DOI 10.1038/sj.eye.6702193.

(73) Zehavi-Dorin T, Heinecke E, Nadkarni S, Green C, Chen C, Kong YXG. Bilateral consecutive Xen gel stent surgery during pregnancy for uncontrolled early-onset primary open angle glaucoma. Am J Ophthalmol Case Reports [Internet]. 2019 Sep;15:100510. DOI 10.1016/j.ajoc.2019.100510.

(74) Arruti N, Rebollo A, Mezquita G, Alcaine A, Andonegui J. Uso de fármacos oculares en el embarazo. An Sist Sanit Navar [Internet]. 2013;36(3):479–87. DOI 10.4321/s1137-66272013000300013.

(75) Jones LV. Acidosis tubular renal. Bol Med Hosp Infant Mex. 2012;69(6):502–8. Disponible en: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-11462012000600011

(76) Yanileidy D, González B, Teresita D, Méndez DJ. Actualización en el tratamiento médico del glaucoma pediátrico. Rev Cuba Oftalmol [Internet]. 2013;26(2):605–14. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-21762013000400008