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Glaucoma

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→‎O Relatório de Recomentação Ampliação de uso do exame de Tomografia de Coerência Óptica para confirmação diagnóstica de glaucoma

• Q15.0 Glaucoma congênito.

== EXAMES DIAGNÓSTICOS DE GLAUCOMA NO SUS ==

== DIAGNÓSTICO ==02.11.06.011-9 - GONIOSCOPIA;

A avaliação oftalmológica do paciente deve ser binocular e abordar os seguintes itens para o diagnóstico do glaucoma e para a determinação da sua gravidade:02.05.02.002-0 - PAQUIMETRIA ULTRASSÔNICA;

• anamnese;02.11.06.003-8 - CAMPIMETRIA COMPUTADORIZADA OU MANUAL COM GRÁFICO.

• medida da acuidade visual (AV) com melhor correção; • exame pupilar para avaliação de reatividade à luz e procura de defeito pupilar aferente relativo; • biomicroscopia de segmento anterior para avaliação da profundidade da câmara anterior, de doenças corneanas ou de causas secundárias para o aumento da PIO; • aferição da PIO, idealmente medida com tonometria de aplanação de Goldmann, em diferentes dias e horários, para reconhecimento da flutuação diária; e avaliação do nervo óptico e da camada de fibras nervosas (CFN) para o fornecimento de informações estruturais sobre o dano glaucomatoso. O nervo óptico deve ser avaliado com biomicroscopia de fundo e fundoscopia sob midríase e ser documentado, idealmente, com retinografia colorida binocular. == Exames complementares == A gonioscopia avalia o ângulo iridocorneano, identificando a amplitude do ângulo da câmara anterior, o grau de pigmentação, a altura da inserção iriana e a configuração da íris. O diagnóstico de GPAA requer uma gonioscopia para excluir o fechamento angular e outras causas de aumento da PIO,como recesso angular, dispersão pigmentar, sinéquias anteriores periféricas, neovascularização de ângulo e precipitados inflamatórios. A paquimetria ultrassônica avalia a espessura corneana central e influencia a estimativa da PIO. A campimetria visual (campimetria computadorizada estática acromática) é o exame padrão-ouro para detectar o dano funcional do glaucoma e para monitorizar sua progressão.  Deve ser realizada documentação do nervo óptico e análise da CFN, conforme já referido,principalmente nos casos suspeitos ou confirmados de glaucoma. A retinografia colorida estereoscópica ésuperior à técnica simples por permitir uma melhor quantificação do anel neural. O uso do filtro aneritracontribui para uma melhor análise qualitativa da CFN. Entretanto, a retinografia simples pode sersuficiente para o seguimento (79,123-132). Não há evidência científica suficiente que embase o uso datomografia de coerência óptica (OCT) para o acompanhamento dos pacientes com glaucoma.  == CRITÉRIOS DIAGNÓSTICOS no NO PCDT (Protocolo clínico de diretrizes terapêuticas do Ministério da Saúde)==

Serão incluídos neste Protocolo pacientes com diagnóstico de glaucoma que apresentem pelo menos dois dos seguintes itens:

- campo visual compatível com o dano ao nervo óptico.

== 5 CRITÉRIOS DE EXCLUSÃO ==:

Serão excluídos deste Protocolo pacientes que apresentarem hipersensibilidade ou contraindicação

aos medicamentos nele preconizados.

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Enhanced corneal compensation for scanning laser polarimetry on eyes withatypical polarisation pattern. Br J Ophthalmol. 2005;89(9):1139-42. 127. Medeiros FA. Comparação dos métodos de imagem do disco óptico e da camada de fibras nervosasda retina Coerência Óptica para o diagnóstico confirmação diagnóstica de glaucoma. São Paulo: Universidade de São Paulo; 2005. 128. Greaney MJ, Hoffman DC, Garway-Heath DF, Nakla M, Coleman AL, Caprioli J. Comparison ofoptic nerve imaging methods to distinguish normal eyes from those with glaucoma. Invest OphthalmolVis Sci. 2002; 43(1):140-5. 129. Deleon-Ortega JE, Arthur SN, McGwin G, Jr., Xie A, Monheit BE, Girkin CA. Discriminationbetween glaucomatous and nonglaucomatous eyes using quantitative imaging devices and subjectiveoptic nerve head assessment. Invest Ophthalmol Vis Sci. 2006; 47(8):3374-80. 130. Badala F, Nouri-Mahdavi K, Raoof DA, Leeprechanon N, Law SK, Caprioli J. Optic disk and nervefiber layer imaging to detect glaucoma. Am J Ophthalmol 2007; 144(5):724-32. 131. Vessani RM, Moritz R, Batis L, Zagui RB, Bernardoni S, Susanna R. Comparison of quantitativeimaging devices and subjective optic nerve head assessment by general ophthalmologists to differentiatenormal from glaucomatous eyes.J Glaucoma 2009; 18(3):253-61. 132. Reus NJ, de Graaf M, Lemij HG. Accuracy of GDx VCC, HRT I, and clinical assessment ofstereoscopic optic nerve head photographs for diagnosing glaucoma. Br J Ophthalmol 2007; 91(3):313-8. 133. Grodum K, Heijl A, Bengtsson B. Refractive error and glaucoma. Acta Ophthalmol Scand. 2001;79(6):560-6. 134. Xu L, Wang Y, Wang S, Wang Y, Jonas JB. High myopia and glaucoma susceptibility the BeijingEye Study.Ophthalmology 2007; 114(2):216-20. 135. Wong TY, Klein BE, Klein R, Knudtson M, Lee KE. Refractive errors, intraocular pressure, andglaucoma in a white population.Ophthalmology 2003; 110(1):211-7. 136. Ramakrishnan R, Nirmalan PK, Krishnadas R, Thulasiraj RD, Tielsch JM, Katz J, et al. Glaucoma ina rural population of southern India: the Aravind comprehensive eye survey. Ophthalmology 2003;110(8):1484-90. 137. Suzuki Y, Iwase A, Araie M, Yamamoto T, Abe H, Shirato S, et al. Risk factors for open-angleglaucoma in a Japanese population: the Tajimi Study. Ophthalmology 2006; 113(9):1613-7. 138. Wu SY, Nemesure B, Leske MC. Glaucoma and myopia. Ophthalmology 2000; 107(6):1026-7. 139. Kuzin AA, Varma R, Reddy HS, Torres M, Azen SP, Los Angeles Latino Eye Study G. Ocularbiometry and open-angle glaucoma: the Los Angeles Latino Eye Study. Ophthalmology 2010;117(9):1713-9. 140. Fingert JH, Heon E, Liebmann JM, Yamamoto T, Craig JE, Rait J, et al. Analysis of myocilinmutations in 1703 glaucoma patients from five different populations. Hum Mol Genet 1999; 8(5):899-905. 141. Gong G, Kosoko-Lasaki O, Haynatzki GR, Wilson MR. Genetic dissection of myocilin glaucoma.Hum Mol Genet. 2004; 13 Spec No 1:R91-102. 142. Kwon YH, Fingert JH, Kuehn MH, Alward WL.Primary open-angle glaucoma. N Engl J Med. 2009;360(11):1113-24. 143. Wiggs JL. Genetic etiologies of glaucoma.Arch Ophthalmol. 2007;125(1):30-7. 144. Sociedade Brasileira de Glaucoma. II Consenso Brasileiro de Glaucoma Primário de Ângulo Fechado [Internet]; 2012 [acesso em Disponível em: http://www.sbglaucoma.com.br/pdf/consenso04.pdf 145. Chen R, Yang K, Zheng Z, Ong ML, Wang NL, Zhan SY. Meta-analysis of the Efficacy and Safetyof Latanoprost Monotherapy in Patients With Angle-closure Glaucoma. J Glaucoma 2016; 25(3):e134-44. 146. Dakin HA, Welton NJ, Ades AE, Collins S, Orme M, Kelly S. Mixed treatment comparison ofrepeated measurements of a continuous endpoint: an example using topical treatments for primary open-angle glaucoma and ocular hypertension. Stat Med. 2011; 30(20):2511-35. 147. Rouse B, Cipriani A, Shi Q, Coleman AL, Dickersin K, Li T. Network Meta-analysis for ClinicalPractice Guidelines: A Case Study on First-Line Medical Therapies for Primary Open-Angle Glaucoma.Ann Intern Med. 2016; 164(10):674-82. 148. Cox JA, Mollan SP, Bankart J, Robinson R. Efficacy of antiglaucoma fixed combination therapyversus unfixed components in reducing intraocular pressure: a systematic review. Br J Ophthalmol. 2008;92(6):729-34. 149. Fung AT, Reid SE, Jones MP, Healey PR, McCluskey PJ, Craig JC. Meta-analysis of randomisedcontrolled trials comparing latanoprost with brimonidine in the treatment of open-angle glaucoma, ocularhypertension or normal-tension glaucoma.Br J Ophthalmol. 2007; 91(1):62-8. 150. Craven ER, Walters TR, Williams R, Chou C, Cheetham JK, Schiffman R, et al. Brimonidine andtimolol fixed-combination therapy versus monotherapy: a 3-month randomized trial in patients withglaucoma or ocular hypertension. J Ocul Pharmacol Ther. 2005; 21(4):337-48.==

151A [https://www. Spaeth GLgov.br/conitec/pt-br/midias/relatorios/portaria/2020/20201113_portaria_sctie_51.pdf PORTARIA SCTIE/MS Nº 51, Bernstein PDE 11 DE NOVEMBRO DE 2020] <ref>[https://www.gov.br/conitec/pt-br/midias/relatorios/portaria/2020/20201113_portaria_sctie_51.pdf PORTARIA SCTIE/MS Nº 51, Caprioli J, Schiffman RMDE 11 DE NOVEMBRO DE 2020]</ref> aprovou o [https://www.gov. Control of intraocular pressure and fluctuationwith fixedbr/conitec/pt-combination brimonidine-timolol versus brimonidine or timolol monotherapybr/midias/consultas/relatorios/2020/20201113_relatorio_de_recomendacao_571_oct.pdf Ampliação de uso do exame de Tomografia de Coerência Óptica para confirmação diagnóstica de glaucoma]. Am JOphthalmol. 2011; 151(1):93 PORTARIA SCTIE/MS Nº 51, DE 11 DE NOVEMBRO DE 2020 Torna pública a decisão de ampliar o uso do exame de Tomografia de Coerência Óptica para confirmação diagnóstica de glaucoma, no âmbito do Sistema Único de Saúde -9 e4SUS.

152Conforme determina o art. Loon SC, Liew G, Fung A25 do Decreto nº 7.646/2011, Reid SE, Craig JC. Meta-analysis of randomized controlled trialscomparing timolol with brimonidine in the treatment of glaucoma. Clin Exp Ophthalmol. 2008;36as áreas técnicas terão o prazo máximo de 180 (3cento e oitenta):281-9dias para efetivar a oferta no SUS.

153. Cheng JW, Li Y, Wei RL. Systematic review of intraocular pressure-lowering effects of adjunctivemedications added to latanoprost. Ophthalmic Res. 2009; 42(2):99-105.== O Relatório de Recomendação da CONITEC ==

154O glaucoma é uma doença progressiva, assintomática até seus estágios avançados e cujas lesões são irreversíveis. Bron AMEstimam-se que cerca de 11,2 milhões de pessoas serão acometidas com cegueira bilateral em 2020, Emmerich KHo que torna o glaucoma a principal causa de cegueira irreversível no mundo atualmente. Latanoprost versus combined timolol and dorzolamide. Surv Ophthalmol.2002; 47 Suppl 1:S148-54O diagnóstico do glaucoma recomendado no PCDT de glaucoma é realizado por exames que se baseiam nos resultados da avaliação estrutural (disco ótico) e funcional (campo visual), associado ao acompanhamento dos níveis de PIO.

155. Cheng JWO exame de Tomografia de Coerência Óptica ou “Optical Coherence Tomography” (OCT) é uma tecnologia computadorizada de imagem, importante ferramenta auxiliar na avaliação dos pacientes com glaucoma, Xi GLcapaz de otimizar a acurácia diagnóstica da doença, Wei RLparticularmente nas fases iniciais, Cai JPpropiciando melhor qualidade da assistência aos pacientes e menor ocorrência de diagnóstico incorreto – “overdiagnosis”, Li Y. Efficacy and tolerability of latanoprost compared todorzolamide combined with timolol in the treatment of patients with elevated intraocular pressure: ameta-analysis of randomizedcom o consequente tratamento e frequência de seguimento desnecessário para indivíduos sem glaucoma, controlled trials. J Ocul Pharmacol Ther. 2009; 25(1):55-64possibilitando alocação mais apropriada/racional dos recursos públicos em saúde.

156. Tanna APForam discutidas e consideradas pelo plenário da Conitec a necessidade de ampliação de uso do exame de OCT para esclarecimento diagnóstico de glaucoma em pacientes suspeitos de glaucoma com algumas características determinas em PCDT do Ministério da Saúde , Rademaker AWsua acurácia e os possíveis custos de implementação da tecnologia, Stewart WCassim como a possibilidade de economia de recursos indiretos (menos consultas, Feldman RM. Meta-analysis of the efficacy and safety ofalpha2-adrenergic agonistsmenos tratamentos, beta-adrenergic antagonists, and topical carbonic anhydrase inhibitors withprostaglandin analogs. Arch Ophthalmol 2010; 128(7menos complicações):825-33para o SUS.

157. Webers CA, van der Valk R, Schouten JS, Zeegers MPOs membros da Conitec presentes na 91ª reunião ordinária, Prins MHno dia 08 de outubro de 2020, Hendrikse F. Intraoculardeliberaram porpressure-lowering effect of adding dorzolamide or latanoprost to timolol: unanimidade recomendar a meta-analysis of randomizedampliação de uso do exame de tomografia de coerência óptica para confirmação diagnósticaclinical trials. Ophthalmology 2007; 114(1):40-6de glaucoma, conforme Protocolo Clínico e Diretrizes Terapêuticas do Ministério da Saúde.Foi assinado o registro dedeliberação nº 565/2020

158. Webers CA, Beckers HJ, Zeegers MP, Nuijts RM, Hendrikse F, Schouten JS. The intraocularpressure-lowering effect of prostaglandin analogs combined with topical beta-blocker therapy: asystematic review and meta-analysis. Ophthalmology. 2010;117(11):2067-74 e1-6.== TRATAMENTO ==

159. Mello PAA, de Almeida GV, de Almeida HG. Glaucoma O objetivo primário do tratamento de ângulo aberto. Rio de Janeiro:Guanabara Koogan; 2011glaucoma é a redução da PIO (pressão intra ocular).

160. Kanski JJO tratamento do glaucoma no Sistema Único de Saúde (SUS) segue o Protocolo Clínico e Diretrizes Terapêuticas (PCDT) do glaucoma, que define as melhores práticas para diagnóstico e tratamento, incluindo medicamentos, Bowling Bcirurgias e a laser. Clinical Ophthalmology: O objetivo do tratamento é controlar a systematic approach. Philadelphia: ElsevierSaunders; 2011pressão intraocular e prevenir a progressão da doença, que pode levar à perda da visão.

161. Vass C, Hirn C, Sycha T, Findl O, Bauer P, Schmetterer L. Medical interventions for primary openangle glaucoma and ocular hypertension. Cochrane Database Syst Rev. 2007; 4'''Medicamentos padronizados no SUS:CD003167.'''

162. van der Valk R, Webers CA, Schouten JS, Zeegers MP, Hendrikse F, Prins MH. Intraocularpressure-lowering effects of all commonly used glaucoma drugs• Timolol: solução oftálmica a meta-analysis of randomized clinicaltrials. Ophthalmology. 20050,5%; 112:1177-85.

163. van der Valk R, Webers CA, Lumley T, Hendrikse F, Prins MH, Schouten JS. A network meta-analysis combined direct and indirect comparisons between glaucoma drugs to rank effectiveness inlowering intraocular pressure. J Clin Epidemiol. 2009• Dorzolamida: solução oftálmica a 2%; 62(12):1279-83.

164. Stewart WC, Konstas AG, Nelson LA, Kruft B. Meta-analysis of 24-hour intraocular pressurestudies evaluating the efficacy of glaucoma medicines. Ophthalmology 2008• Brinzolamida: suspensão oftálmica a 1%; 115(7):1117-22 e1.

165. Cheng JW• Brimonidina: solução oftálmica a 0, Cai JP, Wei RL. Meta-analysis of medical intervention for normal tensionglaucoma.Ophthalmology. 20092%; 116(7):1243-9.

166. Hodge WG, Lachaine J, Steffensen I, Murray C, Barnes D, Foerster V, et al. The efficacy and harmof prostaglandin analogues for IOP reduction in glaucoma patients compared to dorzolamide andbrimonidine• Latanoprosta: solução oftálmica a systematic review. Br J Ophthalmol. 20080,005%; 92(1):7-12.

167. Tsai JC, Chang HW. Comparison of the effects of brimonidine 0.2% and timolol 0.5% on retinalnerve fiber layer thickness in ocular hypertensive patients• Travoprosta: solução oftálmica a prospective0, unmasked study. J OculPharmacol Ther 2005004%; 21(6):475-82.

168. Marchetti A, Magar R, An P• Bimatoprosta: solução oftálmica a 0, Nichol M. Clinical and economic impact of new trends in glaucomatreatment. MedGenMed. 200103%; 3(4):6.

169. Einarson TR, Kulin NA, Tingey D, Iskedjian M. Meta-analysis of the effect of latanoprost andbrimonidine on intraocular pressure in the treatment of glaucoma. Clin Ther. 2000• Pilocarpina: solução oftálmica a 2%; 22(12):1502-15.

170. Sultan MB, Mansberger SL, Lee PP. Understanding the importance of IOP variables in glaucoma• Acetazolamida: asystematic review. Surv Ophthalmol. 2009comprimido de 250 mg; 54(6):643-62.

171. Sena DF, Ramchand K, Lindsley K. Neuroprotection for treatment of glaucoma in adults. CochraneDatabase Syst Rev. 2010;2)• Manitol:CD006539.172. Rouland JF, Le Pen C, Gouveia Pinto C, Berto P, Berdeaux G. Cost-minimisation study ofsolução intravenosa a 20%

dorzolamide versus brinzolamide in the treatment of ocular hypertension and primary open-angleglaucoma: in four European countries. Pharmacoeconomics. 2003; 21(3):201-13.'''Tempo de tratamento'''

173Como o glaucoma é uma doença incurável, o tratamento é contínuo, sem duração pré-determinada, o que exige um adequado acompanhamento oftalmológico. Li SMQuando o tratamento clínico é ineficaz, Chen Rintolerável ou não conta com a adesão do paciente, Li Ya cirurgia antiglaucomatosa deve ser considerada parafins de controle da doença. Pode ser retirado algum hipotensor, Yang ZRcaso seja obtido controle pressórico e estabelecida ausência de progressão da doença, Deng QJou seja, Zhong Zquando o dano ao nervo óptico consegue ser mantido e o campo visual permanece; porém, et alconstatada a progressão da doença, o tratamento medicamentoso deve ser retomado. Meta-analysis of randomized controlledtrials comparing latanoprost with timolol in the treatment of Asian populations with chronic angleCirurgias para tratamento do glaucomaO dano glaucomatoso caracteriza-closureglaucomase pela elevação da pressão intraocular (PIO) à níveis que se tornam danosos ao nervo ótpico. PLoS One. 2014; 9Do ponto de vista intervencional, se pode ou facilitar o escoamento do humor aquoso (muito utilizado) ou diminuir a produção de humor aquoso (5pouco utilizado):e96852.

174. Daka Q, Trkulja V. Efficacy and tolerability of mono-compound topical treatments for reduction ofintraocular pressure in patients with primary open angle glaucoma or ocular hypertension: an overview ofreviews. Croat Med J. 2014; 55(5):468-80.== CIRURGIAS DE GLAUCOMA NO SUS ==

175. Lin LNo SUS são padronizados segundo a Tabela SIGTAP, Zhao YJ, Chew PT, Sng CC, Wong HT, Yip LW, et al. Comparative efficacy and tolerabilityof topical prostaglandin analogues for primary open-angle glaucoma and ocular hypertension. AnnPharmacother. 2014; 48(12)os seguintes procedimentos:1585-93.

17604. Aptel F, Cucherat M, Denis P05. Efficacy and tolerability of prostaglandin analogs: a meta05.032-analysis ofrandomized controlled clinical trials. J Glaucoma 2008; 17(8):6671 -73.TRABECULECTOMIA

17704. Cheng JW, Xi GL, Wei RL, Cai JP, Li Y05. Effects of travoprost in the treatment of open05.004-angleglaucoma or ocular hypertension: A systematic review and meta6 -analysis. Curr Ther Res Clin Exp.2009;70(4):335-50.CICLOCRIOCOAGULACAO / DIATERMIA

17804. Guedes RAP, Guedes VMP, Chaoubah A05. Custo05.005-efetividade dos análogos de prostaglandinas noBrasil. Rev Bras Oftalmol. 2008;67(6):2814 -6.CICLODIALISE

17904. Guedes RAP, Guedes VMP, Borges JL, Chaoubah A05. Avaliação econômica das associações fixas deprostaglandina/prostamida e timolol no tratamento do glaucoma e da hipertensão ocular05. Rev BrasOftalmol. 2010; 69(4):236012-7 -40.FOTOTRABECULOPLASTIA A LASER

18004. Luu KT, Raber SR, Nickens DJ, Vicini P05. A model05.013-based meta5 -analysis of the effect of latanoprostchronotherapy on the circadian intraocular pressure of patients with glaucoma or ocular hypertension.Clin Pharmacol Ther 2010; 87(4):421IMPLANTE DE PROTESE ANTI-5.GLAUCOMATOSA

18104. Orme M, Collins S, Dakin H, Kelly S, Loftus J05. Mixed treatment comparison and meta-regression ofthe efficacy and safety of prostaglandin analogues and comparators for primary open05.017-angle glaucoma andocular hypertension. Curr Med Res Opin 2010; 26(3):5118 -28.IRIDECTOMIA CIRURGICA

18204. Li N, Chen XM, Zhou Y, Wei ML, Yao X05. Travoprost compared with other prostaglandin analoguesor timolol in patients with open-angle glaucoma or ocular hypertension: meta05.018-analysis of randomizedcontrolled trials. Clin Exp Ophthalmol 2006; 34(8):7556 -64.IRIDOCICLECTOMIA

18304. Goldberg LD, Walt J05. Cost considerations in the medical management of glaucoma in the US:estimated yearly costs and cost effectiveness of bimatoprost compared with other medications05.Pharmacoeconomics 2006; 24(3):251019-64.4 - IRIDOTOMIA A LASER

18404. Hedman K, Alm A05. A pooled05.020-data analysis of three randomized, double8 -masked, six-month clinicalstudies comparing the intraocular pressure reducing effect of latanoprost and timolol. Eur J Ophthalmol2000; 10(2):95-104.PARACENTESE DE CAMARA ANTERIOR

185. Zhang WY, Po AL, Dua HS, Azuara-Blanco A. Meta-analysis of randomised controlled trialscomparing latanoprost with timolol in the treatment of patients with open angle glaucoma or ocularhypertension. Br J Ophthalmol 2001; 85(8):983-90.== REGULAÇÃO/CONTROLE/AVALIAÇÃO PELO GESTOR ==

186. Varma RDevem ser observados os critérios de inclusão e exclusão de pacientes neste Protocolo, Hwang LJa duração e a monitorização do tratamento, Grunden JWa verificação periódica das doses prescritas e dispensadas e a adequação de uso e do acompanhamento pós-tratamento. O diagnóstico, Bean GWa indicação terapêutica, Sultan MB. Assessing the efficacy of latanoprost vstimolol using an alternate efficacy parameter: the intervisit intraocular pressure range.Am J Ophthalmol.2009;148a prescrição de medicamento(2s):221-6e o acompanhamento devem ser realizados exclusivamente por médicos oftalmologistas.

187. Honrubia F, Garcia-Sanchez J, Polo V, Verificar na Relação Nacional de la Casa JM, Soto J. Conjunctival hyperaemia with the useof latanoprost versus other prostaglandin analogues in patients with ocular hypertension or glaucoma: ameta-analysis of randomised clinical trials. Br J Ophthalmol. 2009; 93Medicamentos Essenciais (3RENAME):316-21vigente em qual componente da Assistência Farmacêutica se encontram os medicamentos preconizados neste Protocolo.

188. Eyawo OQuanto ao fornecimento dos colírios, Nachega Jo estabelecimento de saúde pode estar credenciado em uma das modalidades de habilitação em oftalmologia no SUS: sob o código 0506 - tratamento do glaucoma com medicamentos no âmbito da Política Nacional de Atenção Oftalmológica, Lefebvre Pno qual é o estabelecimento o responsável pelo fornecimento, Meyer D, Rachlis Bou sob o código 0508 - tratamento do glaucoma com medicamentos, Lee CWcujo fornecimento se dá pelas secretarias estaduais de saúde, et al. Efficacy and safety ofprostaglandin analogues in patients with predominantly primary open-angle glaucoma or ocularhypertension: a meta-analysis. Clin Ophthalmol. 2009; 3:447-56no âmbito do Componente Especializado da Assistência Farmacêutica (CEAF).

189. Eisenberg DL, Toris CB, Camras CB. Bimatoprost and travoprost: a review of recent studies of twonew glaucoma drugs. Surv Ophthalmol. 2002;47 Suppl 1: S105-15.== REFERÊNCIA ==

190https://bvsms. Quaranta L, Biagioli E, Riva I, Rulli E, Poli D, Katsanos A, et alsaude. Prostaglandin analogs and timolol-fixed versus unfixed combinations or monotherapy for open-angle glaucoma: a systematic review andmeta-analysisgov. J Ocul Pharmacol Therbr/bvs/saudelegis/sas/2013/prt1279_19_11_2013. 2013;29(4)html#:~:382-9text=Aprova%20o%20Protocolo%20Cl%C3%ADnico%20e%20Diretrizes%20Terap%C3%AAuticas%20do%20Glaucoma.

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