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A triagem populacional para glaucoma não se mostrou custo-efetiva nos Estados Unidos. Ela
parece ser mais útil quando focada em populações de risco, como idosos, pacientes com familiares
glaucomatosos e indivíduos latinos e afrodescendentes. No Brasil, há carência de estudos de custo�efetividade custo-efetividade da triagem para glaucoma (8,15,17,19-21,72-78).
O tratamento clínico é tópico e semelhante nas diferentes formas de glaucoma. Entretanto, há
A HO tem uma prevalência estimada de 2,7%-7,5% (8), sendo considerada um fator de risco para
conversão para GPAA. Há evidência de que a redução da PIO em pacientes com HO diminui a
progressão para a doença glaucomatosa, existindo, porém, controvérsias no que tange ao custo�efetividade custo-efetividade do tratamento (74).
Os principais fatores associados à conversão para GPAA são idade, etnia negra, PIO aumentada,
exfoliação em pacientes com mais de 65 anos de idade, miopia, diabete melito, história familiar de
ao tratamento, costuma ser prescrita na dose de duas vezes diárias. Reduz a PIO entre 14,7%-27% após 2
horas e entre 12,9%-17,5% após 8 horas. Em 24 horas, há redução média de 18%-22%. Apresenta
eficácia semelhante à do maleato de timolol a 0,5%, inferior à das prostaglandinas e superior à dos alfa�agonistasalfa-agonistas. Estudos mostraram que, quando administrada duas vezes ao dia, apresenta efeito aditivo na
redução da PIO em pacientes usuários de timolol. A combinação fixa de timolol a 0,5% e dorzolamida a
2% está disponível comercialmente, com vários estudos demonstrando equivalência ao uso isolado dos
A monitorização do paciente é fundamental para o controle da doença. Como o glaucoma é uma
afecção crônica, assintomática e com necessidade de uso de múltiplos medicamentos, a relação médico�paciente médico-paciente tem uma importância fundamental (8,74,79,80).
Recomendam-se os seguintes critérios para o acompanhamento (8):
incapacitantes. Embora o aumento da pigmentação iriana seja permanente, o aumento da pigmentação
periocular e o crescimento dos cílios revertem após a suspensão do medicamento. A principal
preocupação quanto à toxicidade corneana, em olhos tratados com análogos de prostaglandina, relaciona�se relaciona-se aos pacientes com história de ceratite por herpes simples. Há relatos de casos em que houve reativação
após o uso de latanoprosta e bimatoprosta. Portanto, é aconselhável iniciar tratamento hipotensor de outra
classe nesses pacientes. Epiteliopatia dendrítica e erosões do epitélio corneano, e sinais de toxicidade
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