aos medicamentos nele preconizados.
== 7 TRATAMENTO O Relatório de Recomentação Ampliação de uso do exame de Tomografia de Coerência Óptica para confirmação diagnóstica de glaucoma ==
A [https://www.gov.br/conitec/pt-br/midias/relatorios/portaria/2020/20201113_portaria_sctie_51.pdf PORTARIA SCTIE/MS Nº 51, DE 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, DE 11 DE NOVEMBRO DE 2020]</ref> aprovou o [https://www.gov.br/conitec/pt-br/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].
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 - SUS.
Conforme determina o art. 25 do Decreto nº 7.646/2011, as áreas técnicas terão o prazo máximo de 180 (cento e oitenta) dias para efetivar a oferta no SUS.
== REFERÊNCIAS O Relatório de Recomendação da CONITEC ==
O glaucoma é uma doença progressiva, assintomática até seus estágios avançados e cujas lesões são irreversíveis. Estimam-se que cerca de 11,2 milhões de pessoas serão acometidas com cegueira bilateral em 2020, o que torna o glaucoma a principal causa de cegueira irreversível no mundo atualmente. O 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.
1. Van Buskirk EM, Cioffi GA. Glaucomatous optic neuropathy. Am J Ophthalmol. 1992;113O exame de Tomografia de Coerência Óptica ou “Optical Coherence Tomography” (4OCT):447-52é uma tecnologia computadorizada de imagem, importante ferramenta auxiliar na avaliação dos pacientes com glaucoma, capaz de otimizar a acurácia diagnóstica da doença, particularmente nas fases iniciais, propiciando melhor qualidade da assistência aos pacientes e menor ocorrência de diagnóstico incorreto – “overdiagnosis”, com o consequente tratamento e frequência de seguimento desnecessário para indivíduos sem glaucoma, possibilitando alocação mais apropriada/racional dos recursos públicos em saúde.
2. Quigley HA. Number of people with Foram discutidas e consideradas pelo plenário da Conitec a necessidade de ampliação de uso do exame de OCT para esclarecimento diagnóstico de glaucoma worldwide.Br J Ophthalmol. 1996;80em pacientes suspeitos de glaucoma com algumas características determinas em PCDT do Ministério da Saúde , sua acurácia e os possíveis custos de implementação da tecnologia, assim como a possibilidade de economia de recursos indiretos (5menos consultas, menos tratamentos, menos complicações):389-93para o SUS.
3. Thylefors BOs membros da Conitec presentes na 91ª reunião ordinária, Negrel ADno dia 08 de outubro de 2020, Pararajasegaram Rdeliberaram porunanimidade recomendar a ampliação de uso do exame de tomografia de coerência óptica para confirmação diagnósticade glaucoma, Dadzie KY. Global data on blindnessconforme Protocolo Clínico e Diretrizes Terapêuticas do Ministério da Saúde. Bull World HealthFoi assinado o registro deOrgan. 1995;73(1):115-21.deliberação nº 565/2020
4. Coral-Ghanem C. Levantamento de casos de glaucoma em Joinville - Santa Catarina, 1984. Arq BrasOftalmol. 1989;52:40-3.== TRATAMENTO ==
5. Medina NH, Barros OMd, Muñoz EdH, Magdaleno RL, Barros AJDd, Ramos LR. Morbidade ocularem idosos O objetivo primário do tratamento de glaucoma é a redução da cidade de São Paulo - SP, Brasil. Arq Bras Oftalmol. 1993;56PIO (5pressão intra ocular):276-78.
6. Sakata KO tratamento do glaucoma no Sistema Único de Saúde (SUS) segue o Protocolo Clínico e Diretrizes Terapêuticas (PCDT) do glaucoma, Sakata LMque define as melhores práticas para diagnóstico e tratamento, Sakata VMincluindo medicamentos, Santini C, Hopker LM, Bernardes R, et alcirurgias e a laser. Prevalence of glaucomain O objetivo do tratamento é controlar a pressão intraocular e prevenir a South brazilian population: Projeto Glaucoma. Invest Ophthalmol Vis Sci. 2007; 48(11):4974-9progressão da doença, que pode levar à perda da visão.
7. Allingham RR, Damji KF, Freedman SF, Moroi SE, Rhee DJ, Shields B. Shields Textbook ofGlaucoma. 5th ed. Philadelphia'''Medicamentos padronizados no SUS: Lippincott Williams & Wilkins; 2005.'''
8. American Academy of Ophthalmology Glaucoma Panel.Preferred Practice Pattern Guidelines.PrimaryOpen-Angle Glaucoma• Timolol: solução oftálmica a 0, 2015 [Internet]5%; [acesso em 19 dez 2017].Disponível em:https://www.aao.org/preferred-practice-pattern/primary-open-angle-glaucoma-ppp-2015
9. Mitchell P, Smith W, Attebo K, Healey PR. Prevalence of open-angle glaucoma in Australia. The BlueMountains Eye Study.Ophthalmology. 1996• Dorzolamida: solução oftálmica a 2%; 103(10):1661-9.
10. Leske MC, Connell AM, Schachat AP, Hyman L. The Barbados Eye Study.Prevalence of open angleglaucoma.Arch Ophthalmol 1994• Brinzolamida: suspensão oftálmica a 1%; 112(6):821-9.
11. Quigley HA• Brimonidina: solução oftálmica a 0, West SK, Rodriguez J, Munoz B, Klein R, Snyder R. The prevalence of glaucoma in apopulation-based study of Hispanic subjects: Proyecto VER. Arch Ophthalmol. 20012%; 119(12):1819-26.
12. Wensor MD• Latanoprosta: solução oftálmica a 0, McCarty CA, Stanislavsky YL, Livingston PM, Taylor HR. The prevalence ofglaucoma in the Melbourne Visual Impairment Project.Ophthalmology. 1998005%; 105 (4):733-9.
13. Tielsch JM, Sommer A, Katz J, Royall RM• Travoprosta: solução oftálmica a 0, Quigley HA, Javitt J. Racial variations in the prevalenceof primary open-angle glaucoma. The Baltimore Eye Survey.JAMA. 1991004%; 266 (3):369-74.
14. Friedman DS• Bimatoprosta: solução oftálmica a 0, Jampel HD, Munoz B, West SK. The prevalence of open-angle glaucoma amongblacks and whites 73 years and older: the Salisbury Eye Evaluation Glaucoma Study. Arch Ophthalmol.200603%; 124(11):1625-30.
15. Wolfs RC, Klaver CC, Ramrattan RS, van Duijn CM, Hofman A, de Jong PT. Genetic risk of primaryopen-angle glaucoma. Population-based familial aggregation study.Arch Ophthalmol. 1998• Pilocarpina: solução oftálmica a 2%;116(12):1640-5.
16. Doshi V, Ying-Lai M, Azen SP, Varma R, Los Angeles Latino Eye Study G. Sociodemographic,family history, and lifestyle risk factors for open-angle glaucoma and ocular hypertension. The LosAngeles Latino Eye Study.Ophthalmology. 2008• Acetazolamida: comprimido de 250 mg; 115(4):639-47 e2.
17. Tielsch JM, Katz J, Sommer A, Quigley HA, Javitt JC. Family history and risk of primary open angleglaucoma. The Baltimore Eye Survey.Arch Ophthalmol. 1994; 112(1)• Manitol:69-73.solução intravenosa a 20%
18. Leske MC, Wu SY, Nemesure B, Hennis A. Incident open-angle glaucoma and blood pressure. ArchOphthalmol. 2002; 120(7):954-9.'''Tempo de tratamento'''
19Como o glaucoma é uma doença incurável, o tratamento é contínuo, sem duração pré-determinada, o que exige um adequado acompanhamento oftalmológico. Friedman DSQuando o tratamento clínico é ineficaz, Wolfs RCintolerável ou não conta com a adesão do paciente, O'Colmain BJa cirurgia antiglaucomatosa deve ser considerada parafins de controle da doença. Pode ser retirado algum hipotensor, Klein BEcaso seja obtido controle pressórico e estabelecida ausência de progressão da doença, Taylor HRou seja, West Squando 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. Prevalence of openCirurgias para tratamento do glaucomaO dano glaucomatoso caracteriza-angle glaucoma among adults in the United Statesse pela elevação da pressão intraocular (PIO) à níveis que se tornam danosos ao nervo ótpico. Arch Ophthalmol. 2004; 122Do ponto de vista intervencional, se pode ou facilitar o escoamento do humor aquoso (muito utilizado) ou diminuir a produção de humor aquoso (4pouco utilizado):532-8.
20. Hernandez RA, Burr JM, Vale LD, Group OAGSP. Economic evaluation of screening for open-angleglaucoma. Int J Technol Assess Health Care. 2008; 24(2):203-11.== CIRURGIAS DE GLAUCOMA NO SUS ==
21. Klein BENo SUS são padronizados segundo a Tabela SIGTAP, Klein R, Lee KE. Heritability of risk factors for primary open-angle glaucoma: the BeaverDam Eye Study. Invest Ophthalmol Vis Sci. 2004; 45(1)os seguintes procedimentos:59-62.
2204. Bonomi L, Marchini G, Marraffa M, Bernardi P, Morbio R, Varotto A05. Vascular risk factors forprimary open angle glaucoma: the Egna05.032-Neumarkt Study. Ophthalmology.2000; 107(7):12871 -93.TRABECULECTOMIA
2304. Mitchell P, Smith W, Chey T, Healey PR05. Open05.004-angle glaucoma and diabetes: the Blue Mountainseye study, Australia. Ophthalmology. 1997; 104(4):7126 -8.CICLOCRIOCOAGULACAO / DIATERMIA
2404. Leske MC, Connell AM, Wu SY, Hyman LG, Schachat AP05. Risk factors for open05.005-angle glaucoma.The Barbados Eye Study.Arch Ophthalmol. 1995; 113(7):9184 -24.CICLODIALISE
2504. Mitchell P, Hourihan F, Sandbach J, Wang JJ05. The relationship between glaucoma and myopia: theBlue Mountains Eye Study05. Ophthalmology. 1999; 106 (10):2010012-7 -5.FOTOTRABECULOPLASTIA A LASER
2604.05. Wang JJ, Mitchell P, Smith W05. Is there an association between migraine headache and open013-5 -angleglaucoma? Findings from the Blue Mountains Eye Study.Ophthalmology. 1997;1 04(10):1714IMPLANTE DE PROTESE ANTI-9.GLAUCOMATOSA
2704. Broadway DC, Drance SM05. Glaucoma and vasospasm05. Br J Ophthalmol. 1998; 82(017-8):862-70.IRIDECTOMIA CIRURGICA
2804. Cursiefen C, Wisse M, Cursiefen S, Junemann A, Martus P, Korth M05. Migraine and tension headachein high05.018-pressure and normal6 -pressure glaucoma. Am J Ophthalmol. 2000; 129(1):102-4.IRIDOCICLECTOMIA
2904. Armaly MF, Krueger DE, Maunder L, Becker B, Hetherington J, Jr05., Kolker AE, et al05. Biostatisticalanalysis of the collaborative glaucoma study. I. Summary report of the risk factors for glaucomatousvisual019-field defects. Arch Ophthalmol. 1980; 98(12):21634 -71.IRIDOTOMIA A LASER
3004. Dielemans I, Vingerling JR, Algra D, Hofman A, Grobbee DE, de Jong PT05.05. Primary open020-angleglaucoma, intraocular pressure, and systemic blood pressure in the general elderly population. TheRotterdam Study.Ophthalmology. 1995; 102(1):548 -60.PARACENTESE DE CAMARA ANTERIOR
31. Mitchell P, Lee AJ, Rochtchina E, Wang JJ. Open-angle glaucoma and systemic hypertension: theblue mountains eye study. J Glaucoma. 2004; 13(4):319-26.== REGULAÇÃO/CONTROLE/AVALIAÇÃO PELO GESTOR ==
32. Gordon MODevem ser observados os critérios de inclusão e exclusão de pacientes neste Protocolo, Beiser JAa duração e a monitorização do tratamento, Brandt JD, Heuer DKa verificação periódica das doses prescritas e dispensadas e a adequação de uso e do acompanhamento pós-tratamento. O diagnóstico, Higginbotham EJa indicação terapêutica, Johnson CA, et al. The OcularHypertension Treatment Study: baseline factors that predict the onset of primary open-angle glaucoma.Arch Ophthalmol. 2002; 120a prescrição de medicamento(6s):714-20; discussion 829-30e o acompanhamento devem ser realizados exclusivamente por médicos oftalmologistas.
33. Shah S, Chatterjee A, Mathai M, Kelly SP, Kwartz J, Henson D, et al. Relationship between cornealthickness and measured intraocular pressure in a general ophthalmology clinic. Ophthalmology. 1999;106:2154-60Verificar na Relação Nacional de Medicamentos Essenciais (RENAME) vigente em qual componente da Assistência Farmacêutica se encontram os medicamentos preconizados neste Protocolo.
34. Whitacre MMQuanto ao fornecimento dos colírios, Stein RAo 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, no qual é o estabelecimento o responsável pelo fornecimento, ou sob o código 0508 - tratamento do glaucoma com medicamentos, cujo fornecimento se dá pelas secretarias estaduais de saúde, Hassanein K. The effect of corneal thickness on applanation tonometry.AmJ Ophthalmol. 1993; 115no âmbito do Componente Especializado da Assistência Farmacêutica (5CEAF):592-6.
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