Management of Angle Closure Glaucoma in a Myopic Pregnant Woman during the COVID-19 Pandemic – A Case Journey

Abstract

Introduction: We present a case of a young Caucasian myopic patient with secondary ACG and the management during her pregnancy amidst the COVID-19 pandemic. Angle closure glaucoma (ACG) is an uncommon condition in younger myopic individuals. Thus, ACG in pregnancy is not well researched and no definitive guidelines exist for its treatment. Case Report: This 27-year-old female patient had been diagnosed with hypertensive uveitis and referred to the glaucoma clinic where peripheral anterior synechiae (PAS) was noticed on gonioscopy. As she had subacute angle closure glaucoma symptoms, she had been started on topical pilocarpine drops. She remained stable and under our regular follow up (dates). At her review in January 2021, she notified us that she was 27 weeks pregnant. She had continued pilocarpine drops once a day. Pilocarpine is a category C drug (with potential foetal risk though lack of human studies). Pilocarpine was advised to be stopped in the clinic as intra-ocular pressure is known to stabilise during pregnancy. She was further reviewed in the third trimester and had an uneventful delivery with a healthy baby. Her last review was post-pregnancy. She remained asymptomatic and her intra-ocular pressures were stable for the entire duration. Conclusion: Our case was an unusual presentation of subacute angle closure secondary to PAS in a young myopic female. Her management of pregnancy in the COVID-19 pandemic when secondary to the social distancing rules was challenging as the clinic reviews are limited. We successfully managed timely reviews without risking the patient or the baby of any potential side effects to pilocarpine or COVID-19.