Rhee said, citing a study from Survey of Ophthalmology. Amtimetabolites such as 5-fluorouracil 5-FU and mitomycin C and prostaglandin analogues are medications to definitely avoid during pregnancy, he said. Selective or argon laser trabeculoplasty are potential surgical solutions for pregnant patients, he said. If those are not successful, some investigators have suggested cylcophotocoagulation as a good option, Dr.
Trabeculectomy without anti-metabolites or post-op anti-inflammatory medication is another procedure to try. Still, the surgical methods have a lower success rate because of the young age of the patients. By the time the patient has delivered the baby and is nursing, glaucoma practitioners can once again consider how much the patient needs her medications.
A switch to bottle feeding for the newborn may be the best option so the patient can resume their medicine, Dr. Davis and Rhee have no financial interests related to their comments. Davis: , eadavis mneye.
Soft contact lens-related corneal infiltrate in a year-old woman. Infiltrates such as this one may require extra care in a pregnant patient. Source: Christopher J. Tags: cornea , glaucoma , medication , refractive surgery. Next Post Complex cataract surgery coding: A refresher course. Slit-lamp examination showed resolving radial perineuritis and decreased stromal haze.
Given her improving status on these medications, no changes were made to her drops. Two weeks later she returned with greatly improved photophobia and reactive ptosis. At this time, her exam showed continued resolution of the radial perineuritis with scattered anterior stromal opacities, along with new deep stromal neovascularization of the cornea peripherally.
In light of the neovascularization felt likely related to a secondary inflammatory response and her excellent response to anti-acanthamoebic medications, prednisolone drops were started three times per day.
After initiating the topical steroid therapy, the neovascularization receded. The anti-acanthamoebic medications and topical steroids were slowly tapered. Systemic absorption of topical ophthalmic medications is a well-established phenomenon and can contribute to unintended systemic effects. These effects are generally negligible in otherwise healthy patients, but must be considered carefully in select populations such as in pregnant women and children.
There are a number of ways to minimize systemic absorption of topical medications, but these methods do not prevent it completely. Therefore, careful consideration must be taken to avoid unintended systemic effects. Small forniceal capacity and the rapid washout of medications by tears limit the absorption of topical ophthalmic medications.
As a result, ocular medications are often extremely potent to achieve clinically significant concentrations in the eye. Of the medication that remains, some is absorbed through the cornea and conjunctiva while the remainder flows through the canaliculi and nasolacrimal ducts, eventually reaching the nasal mucosa where the predominant absorption of ophthalmic medication occurs.
Medication absorbed from this surface reaches the bloodstream directly. In one study, timolol instilled in one eye was found to cause a statistically significant drop in intraocular pressure of the contralateral eye secondary to spread through the systemic circulation 5. Strategies to prolong ocular exposure to the medication can be utilized to minimize systemic absorption and maximize ocular absorption. These include manual nasolacrimal occlusion, use of punctal plugs, use of topical drops with higher viscosities, use of gels or ointments as opposed to drops, and the addition of vasoconstrictors 6.
Limited data has been collected on the effects of medications used topically in the treatment of ocular disease during pregnancy. Though some of these medications may be contraindicated for systemic use, the low doses and nature of topical administration often lead to increased safety for ocular use. Table 1 shows the U. Food and Drug Administration FDA use-in-pregnancy categories and their definitions, which are often used as guides in selecting appropriate medications for use in pregnant women 7.
Table 2 shows the FDA categories for many commonly used ophthalmic medications 8. Most of these medications are in category C, indicating that there are no adequate and well-controlled studies in pregnant women.
It is worth noting that categorization and definitions are different depending upon the country. It is likely that these categorizations will change. In December , The U. Food and Drug Administration issued new rules for product labeling for human prescription drugs regarding pregnancy and lactation labeling.
For human prescription drug and biological products subject to the Agency's Physician Labeling Rule, the final rule requires that the labeling include a summary of the risks of using a drug during pregnancy and lactation, a discussion of the data supporting that summary, and relevant information to help health care providers make prescribing decisions and counsel women about the use of drugs during pregnancy and lactation.
Table 1. A Adequate, well-controlled studies in pregnant women have not shown an increased risk of fetal abnormalities. B Animal studies have revealed no evidence of harm to the fetus; however, there are no adequate and well-controlled studies in pregnant women OR animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus.
C Animal studies have shown an adverse effect, and there are no adequate and well-controlled studies in pregnant women OR no animal studies have been conducted, and there are no adequate and well-controlled studies in pregnant women. D Studies, adequate well-controlled or observational, in pregnant women have demonstrated a risk to the fetus.
However, the benefits of therapy may out-weigh the potential risk. Treatment should be monitored closely. X Studies, adequate well-controlled or observational, in animals or pregnant women have demonstrated positive evidence of fetal abnormalities. The use of the product is contraindicated in women who are or may become pregnant. Table 2. Commonly used ophthalmic medications and their pregnancy categories.
Ocular Anti-Hypertensives topical unless otherwise specified. Further investigation and consideration on your part may be warranted when prescribing ophthalmic dosage forms 8. In this case, chlorhexidine and PHMB drops were used to treat the amoebic infection.
A PubMed search for each of these medications returned no results regarding ocular therapeutic use in pregnant humans. However, chlorhexidine has been used for many years as an oral rinse to treat periodontal disease and multiple randomized controlled trials have demonstrated no increased risks to the fetus when used in pregnant women Given the minimized absorption with punctal occlusion and lack of known adverse effects, we decided to proceed with treatment.
A case report from Sweden describes a similar patient who was pregnant, in the first trimester, and presented with conjunctival injection, stromal keratitis, and a 1 mm hypopyon in the setting of soft contact lens wear.
She was also treated unsuccessfully with antibiotics and steroids. Corneal biopsy and contact lens culture confirmed Acanthamoeba infection. Mydriatic reversal agents are not essential and should not be administered. Brimonidine carries a Category B rating and appears as one of the safer glaucoma medications to use during pregnancy.
It should not be used during lactation, however, as its use has been associated with infant and neonatal central nervous system depression. Erythromycin ophthalmic ointment is the only antibiotic classified as Category B. After any eye drop is instilled, whether in the office or at home, lacrimal sac compression and eye drop closure techniques should be used.
Patients should be instructed to close their eyes while the lacrimal sac is compressed for 2 to 3 minutes. Removal of excess medication and tears with an absorbent tissue also limits systemic absorption and should be performed. Allergy mediciations: antazoline, naphazoline, pheniramine, oxymetazoline, tetrahyrdozoline, zinc sulfate, olopatadine, pemirolast, ketotifen, epinastine, azelastine. Steroids: rimexolone, loteprednol, prednisolone, fluorometholone, dexamethasone.
If necessary during the last two trimesters, use a 0. Beta-blockers should be discontinued at least 48 to 72 hours prior to delivery. Infants of nursing mothers must be observed for signs of beta blockade apnea, bradycardia.
Contraindicated in pregnant and nursing mothers due to abnormal bone development in the fetus and infant. Risk cannot be ruled out, although found to be largely compatible with lactation.
It is the responsibility of each prescriber to personally and independently verify any and all information. Postpartum diarrhea after a C-section is normal. Health Conditions Discover Plan Connect.
Symptoms of dry eyes during pregnancy. Causes of dry eyes during pregnancy. Pregnancy-safe remedies for dry eyes. Treatment for serious dry eyes and other eye changes. The takeaway. Parenthood Pregnancy Pregnancy Health. Maintaining a Healthy Pregnancy. Read this next. Medically reviewed by Debra Rose Wilson, Ph. Medically reviewed by Stacy Sampson, D.
0コメント