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April 1991

Glaucoma Treatment and Pregnancy

Arch Ophthalmol. 1991;109(4):463. doi:10.1001/archopht.1991.01080040023002

To the Editor.  —I read with interest the answer to the question, "What antiglaucomatous medications are safe to use during pregnancy?" in the "Questions and Answers" Section in the November 1990 issue of the Archives.1 Dr Spaeth states, "Women of childbearing age should be cautioned against conceiving while they are receiving carbonic anhydrase inhibitors since they are known to be teratogenic. In contrast,... the miotics, sympathomimetics, and β-blockers... are not thought to be teratogenic in the doses used in ophthalmology."This is not correct. Although the carbonic anhydrase inhibitors are well known to cause reproducible forelimb defects in rodents,2 they have never been proven to be teratogenic in humans or even in nonhuman primates.3 In fact, at least one small series described 12 women who took acetazolamide with no defects observed in their offspring.4 Furthermore, both pilocarpine hydrochloride5 and the sympathomimetics6 have also produced