The expression of cyclooxygenase 2 in retinoblastoma: primary enucleated eyes and enucleation after conservative treatment.

PURPOSE: To provide insight into the relationship between cyclooxygenase-2 (COX-2) expression and histopathologic features of retinoblastoma specimens treated either by primary or secondary enucleation. DESIGN: Laboratory investigation. METHODS: Twenty-five retinoblastoma specimens received between 1994 and 2003 were retrieved for this study from the Ocular Pathology Registry, Federal University of São Paulo, Brazil and the Henry C. Witelson Ocular Pathology Laboratory and Registry, McGill University, Montreal, Canada. The specimens retrieved were divided into two groups: Group I, enucleation was performed as a form of primary treatment (n = 15) and Group II, enucleation after failure of conservative treatment (n = 10). Patient information and formalin-fixed, paraffin-embedded specimens were obtained. New sections of these blocks were used for hematoxylin and eosin stain and for immunoassay using a monoclonal mouse anti-COX-2 antibody. Two independent ophthalmic pathologists reviewed all of the microslides. RESULTS: Twenty-three specimens (92%) presented a high expression of COX-2 (15 in Group I; eight in Group II) and there was no statistical difference in COX-2 expression between the two groups (P = .07). However, all specimens expressed COX-2 to a different degree. The areas of tumor invasion were positive for COX-2 in 87.5% of the two groups. CONCLUSION: Most retinoblastoma specimens revealed a high COX-2 expression. Future studies will be necessary to correlate the high expression of COX-2 in retinoblastoma and a possible applicability of anti-COX-2 medications in the treatment of these tumors.

The effect of blue light exposure and use of intraocular lenses on human uveal melanoma cell lines.

Little is known about the effect of blue light on inducing melanocytic malignant transformation. We chose to investigate the effect of blue light (475 nm wavelength) on the proliferation rates of uveal melanoma cells. In addition, we tested two different intraocular lenses to determine the possible effects of ultraviolet absorbing and blue light filtering intraocular lenses on the changes in proliferation. Four human uveal melanoma cell lines (92.1, MKT-BR, OCM-1, SP6.5) were exposed to blue light with and without the presence of ultraviolet absorbing and blue light filtering intraocular lenses. Cells covered by aluminum foil were used as a control. The proliferation rate of the cells compared with the control was then assessed using the Sulforhodamine-B proliferation assay. Cells exposed to blue light showed a statistically significant (P<0.05) increase in proliferation. Those exposed to blue light through a standard ultraviolet absorbing intraocular lens showed a smaller increase in proliferation, whereas those exposed with a blue light filtering intraocular lens showed no increase in proliferation than the control in all four cell lines. The exposure of cells to blue light led to an increase in proliferation in all cell lines compared with the control. The use of blue light filtering intraocular lenses abolished these increases in proliferation in the four cell lines. These results indicate that blue light filtering intraocular lenses may have a protective effect on the proliferation rates of uveal melanoma cells exposed to blue light.

[Choroidal neovascularization associated with sympathetic ophthalmia: case report]. / Neovascularização coroidiana associada à oftalmia simpática: relato de caso.

A 7-year-old boy with sympathetic ophthalmia secondary to penetrating ocular trauma developed choroidal neovascularization in the macular region of the sympathizing eye. Posterior segment biomicroscopy disclosed a single, round, small, slightly elevated yellow-white lesion temporal to the fovea, linked to the temporal edge of the optic disc by a fibrotic band. On fluorescein angiography the round lesion showed a gradual hyperfluorescence, with late staining and leakage, and was interpreted as a fibrovascular scar from previous choroidal neovascularization. Despite intense immunosuppressive therapy, the patient's final visual acuity was 20/400. Although rarely associated with sympathetic ophthalmia, choroidal neovascularization and its cicatricial stages can occur and compromise the visual prognosis of an already debilitated eye. The best course of treatment for choroidal neovascularization in these types of cases has not yet been determined.

[Histopathologic findings in retinoblastoma]. / Achados histopatológicos em retinoblastoma.

OBJECTIVE: To study histopathological findings of enucleated eyes with retinoblastoma. METHODS: Twenty-eight cases of retinoblastoma treated by enucleation at the Federal University of São Paulo from December 2000 to October 2002 were histopathologically reviewed. Clinical data included age, gender, race, unilateral or bilateral involvement and previous treatment. The histopathological review evaluated the presence of iris and/or angle neovascularization, tumor differentiation and optic nerve and choroidal invasion according to Khelfaoui's classification. RESULTS: Of 27 patients, 13 (48.5%) were boys and 14 (59.3%) were girls, 16 were white, 6 were black and 5 were asiatic, age ranging from 2 to 96 months (mean, 22.7 months). 13 cases were bilateral and 14 cases were unilateral. All tumors were histologically characterized by a proliferation of small cells with high nuclear-to-cytoplasmic ratios and 20 (71.4%) of them were well differentiated. Choroidal involvement was observed in 18 (64.2%) cases (degree II, III) and optic nerve invasion in 8 (28.5%) cases (degree III, IV, V). CONCLUSION: Neovascularization, necrosis and calcification were the most commonly observed feature. The invasion into the optic nerve and choroid, which are the two most important predictors of patient outcome were found in 28.5% and 64.2% of the cases, respectively.

Cytokeratin expression in corneal dystrophies.

PURPOSE: To identify an immunohistochemical pattern of epithelial markers in granular, lattice and Avellino corneal dystrophies. METHODS: Twenty-two corneal buttons, diagnosed as lattice (17), Avellino (4) and granular (1) underwent immunohistochemical studies of cytokeratins (CKs) on paraffin-embedded sections (group I). Monoclonal antibodies for pan-CK (AE1/AE3) and CKs 3/12, 5/6, 8, 18 and 19 were used. Twenty-two normal corneas were used as the control (group II). RESULTS: Six lattice and 2 Avellino cases of group I stained positively with anti-CK 3/12 in corneal epithelium and areas of corneal stroma deposits. One of these cases of lattice was positive for anti-pan-CK (AE1/AE3) also in the epithelium and areas of corneal stroma deposits with a similar pattern. None of the controls (group II) revealed any staining in corneal stroma. All disease and control cases (groups I and II) revealed positive staining in corneal epithelium. CONCLUSION: AE1/AE3 and CK 3/12 anti-CK positive markers in the stromal deposits of lattice and Avellino dystrophies may suggest an epithelial genesis of the disease.

Fine needle aspiration biopsy to reestablish cell culture in an animal model of uveal melanoma.

PURPOSE: To access the reliability of fine-needle aspiration biopsy in harvesting a sufficient amount of viable melanoma cells to establish a cell culture and maintain a melanoma cell line from an animal model of uveal melanoma. METHODS: For this study, fifteen male New Zealand albino rabbits had their right eye surgically inoculated with uveal melanoma cell line 92.1. The animals were immunosupressed with cyclosporine A using a dose schedule previously published. The animals were followed for 12 weeks. Intraocular tumor growth was monitored weekly by indirect ophthalmoscopy. After the fourth week, one animal was sacrificed per week preceded by fine-needle aspiration biopsy using a sharp 25-gauge, 1-inch long needle. Two separate aspirates were made from different areas of the tumor. Each aspirate was flushed to a separate cell culture media and sent for cell culture. The cells were frozen after two weeks when there were at least 1 million cells, which is enough to maintain a cell line. Cells were defrosted for HMB-45 immuno-stains to confirm the melanoma origin. RESULTS: Cell growth was observed from the samples harvested from 11 out of the 15 animals inoculated with uveal melanoma. All cell cultures, after defrost, immunoassayed positive for HMB-45. CONCLUSION: Fine needle aspiration biopsy seems to be a reliable method to harvest cells from solid intraocular melanomas in an animal model, to establish cell culture and to maintain a melanoma cell line.

Schwannoma em pálpebra superior esquerda em criança de 10 anos / Schwannoma of the left superior eyelid in a 10-year-old child

Schwannoma é um tumor neurogênico benigno raro, originário das células de Schwann da bainha de mielina dos nervos periféricos. Sua localização nos tecidos oculares não é comum, sendo a órbita o local afetado com maior frequência e o acometimento das pálpebras é muito raro. Há poucos relatos descritos na literatura sobre Schwannoma palpebral, apenas dois em crianças. Este é, em nosso conhecimento, o primeiro caso relatado no Brasil.

Schwannoma is a rare benign neurogenic tumor. It arises from Schwann cells located at the myelin sheath of peripheral nerves. Its incidence is frequently associated with the orbit. Ocular tissues in general and eyelids in particular are rarely affected. Very few reports can be found in the literature describing eyelid schwannomas. Amongst these, we have found only two describing it affecting children. To our knowledge, this is the first case report about eyelid schwanomma in Brazil - and it involves a child.

Malignancy in the blind painful eye--report of two cases and literature review.

BACKGROUND: Few cases of malignant tumors arising in a blind painful eye have previously been described. We described two cases of a blind painful eye containing an unsuspected tumor, which were enucleated to relieve the pain. CASE PRESENTATIONS: Case 1: A 57 year-old Caucasian man presented with recurrent orbital cellulitis and endophthalmitis in the left eye (OS). The OS was blind and painful and an enucleation was performed showing a uveal melanoma by histopathological exam. Case 2: A 54 year-old Caucasian man with previous history of a rhegmatogenous retinal detachment in his left eye presented a blind painful eye. Enucleation was performed revealing a well-differentiated B-cell lymphoma of uveal tract with extra ocular extension. CONCLUSION: In the management of a blind painful eye, it is extremely important to rule out an intraocular malignancy particularly in those patients who have not been followed by an ophthalmologist.

Cytokeratin expression in corneal dystrophies / Expressão de citoqueratinas em distrofias corneanas

PURPOSE: To identify an immunohistochemical pattern of epithelial markers in granular, lattice and Avellino corneal dystrophies. METHODS: Twenty-two corneal buttons, diagnosed as lattice (17), Avellino (4) and granular (1) underwent immunohistochemical studies of cytokeratins (CKs) on pa- raffin-embedded sections (group I). Monoclonal antibodies for pan-CK (AE1/AE3) and CKs 3/12, 5/6, 8, 18 and 19 were used. Twenty-two normal corneas were used as the control (group II). RESULTS: Six lattice and 2 Avellino cases of group I stained positively with anti-CK 3/12 in corneal epithelium and areas of corneal stroma deposits. One of these cases of lattice was positive for anti-pan-CK (AE1/AE3) also in the epithelium and areas of corneal stroma deposits with a similar pattern. None of the controls (group II) revealed any staining in corneal stroma. All disease and control cases (groups I and II) revealed positive staining in corneal epithelium. CONCLUSION: AE1/AE3 and CK 3/12 anti-CK positive markers in the stromal deposits of lattice and Avellino dystrophies may suggest an epithelial genesis of the disease.

OBJETIVO: Investigar a expressão de citoqueratinas (CKs) em córneas com distrofias corneanas tipo granular, lattice e Avellino. MÉTODOS: Vinte e dois botões corneanos com diagnóstico anatomopatológico de distrofia estromal tipo lattice (17), Avellino (4) e granular (1) foram submetidos à avaliação imunohistoquímica nos tecidos inclusos em parafina (grupo I). Anticorpos monoclonais para pan-CK (AE1/AE3) e CKs de números 3/12, 5/6, 8, 18 e 19 foram utilizados. Vinte e dois botões corneanos normais foram usados como controle (grupo II). RESULTADOS: Oito casos do grupo I (seis lattice e dois Avellino) apresentaram reações imuno-histoquímicas positivas com anti-CK 3/12, tanto no epitélio como nos depósitos estromais e um destes casos (lattice) também se mostrou positivo para anti-pan-CK (AE1/AE3) com o mesmo padrão de reação. Nenhum caso do grupo II mostrou reação imuno-histoquímica positiva no estroma corneano. Na avaliação imuno-histoquímica dos grupos I e II, o epitélio apresentou uma reação positiva com o anticorpo anti-pan-CK (AE1/AE3) e com o anti-CK 3/12. CONCLUSÃO: O fato da pan-CK e CK 3/12 apresentarem uma reação positiva nos depósitos das distrofias tipo lattice e Avellino sugere uma origem epitelial desses depósitos corneanos.

Retinocoroidite toxoplásmica reativada provavelmente por cirurgia refrativa: laser in situ keratomileusis - LASIK / Probable reactivation of toxoplasmic retinochoroiditis by refractive surgery: laser in situ keratomileusis - LASIK

O presente trabalho objetiva demonstrar provável relaço entre recorrência de toxoplasmose ocular e cirurgia refrativa (LASIK). Trata-se de relato de caso de um paciente de 33 anos de idade com recorrência de retinocoroidite toxoplásmica após cirurgia de LASIK. O exame fundoscópico do olho esquerdo revelou foco de retinocoroidite em atividade, satélite a cicatriz antiga de toxoplasmose ocular, 17 dias após cirurgia de LASIK. Os autores apresentam subsídios para o estabelecimento de relação causal entre LASIK e a reativação de retinocoroidite toxoplasmática.

The aim of this article is to demonstrate the probable relationship between the recurrence of toxoplasmic retinochoroiditis and refractive surgery (LASIK). The case consists in a toxoplasmic retinochoroditis recurrence observed in a 33-year-old patient after a LASIK surgery. Fundoscopy revealed a retinochoroiditis focus in activity in the left eye seventeen days after the surgery, adjacent to an old scar of ocular toxoplasmosis. The authors present findings that reinforce possible causal links between LASIK and the recurrence of toxoplasmic retinochoroiditis.

Traumatic tear of the inferior rectus muscle treated with inferior oblique anterior transposition.

PURPOSE: To report a case of traumatic tear of the inferior rectus muscle treated with inferior oblique anterior transposition (IOAT). METHODS: Case report of a 55-year-old man who presented with vertical diplopia (VD) after orbital trauma. Ocular examination disclosed a 62PD right hypertropia (RHT) in the primary position (PPO). The right inferior rectus (RIR) was torn, and the distal stump was fixed to the skin with tape. RESULTS: Surgery was performed under local anesthesia. The RIR tearing occurred 13 mm from the insertion, and exploration revealed its proximal end. The right inferior oblique (RIO) was intact, although its fibers were loose. Since the RHT did not improve following reattachment of the proximal and distal stumps of the RIR, the distal stump was excised and the proximal end brought forward and sutured 6.5 mm from the limbus. At perioperative evaluation, there was a 25PD RHT in PPO where the VD persisted. The RIO was subsequently isolated, detached, and its distal end, after 6 mm resection, was sutured to a point temporal to the lateral border of the RIR. The patient was reevaluated and had neither RHT nor VD in primary gaze. At the 6-week postoperative evaluation, he was orthotropic in PPO, complaining about diplopia only on extreme downgaze. A mild limitation of right depression was observed. The patient was satisfied with the surgical results and experienced no functional limitations during any activities. CONCLUSION: IOAT can provide acceptable binocular visual function without the risk of anterior segment ischemia in cases of torn inferior rectus muscle.

Late-stage diffuse unilateral subacute neuroretinitis: photocoagulation of the worm does not improve the visual acuity of affected patients.

BACKGROUND AND OBJECTIVE: To evaluate the visual outcome following direct laser photocoagulation of the worm in patients with late-stage diffuse unilateral subacute neuroretinitis (DUSN). PATIENTS AND METHODS: The study reports on 22 DUSN patients diagnosed in its late stage, in whom the worm was identified and subsequently destroyed by laser photocoagulation. Information gathered included initial and final visual acuities and length of follow-up. Statistical analysis was performed with the Paired Student's t-Test. A p value of less than 0.05 was considered significant. RESULTS: After a mean follow-up of 13.1 months, visual acuity improved in 2 patients, remained unchanged in 19 patients and decreased in one patient. Comparison of the visual outcome before and after laser treatment was not statistically significant (p = 0.302). CONCLUSION: Destruction of the worm by laser photocoagulation in eyes with late-stage DUSN does not improve the visual acuity of affected patients.

Histopathological review of sebaceous carcinoma of the eyelid.

BACKGROUND: Sebaceous carcinoma of the eyelid can clinically mimic benign conditions, such as recurrent chalazion and inflammation and histopathologically squamous cell and basal cell carcinoma (BCC). This retrospective study was undertaken as an attempt to improve the characterization and consequently the diagnosis of these tumors. METHODS: Retrospective analysis was performed on eyelid specimens diagnosed as sebaceous carcinoma retrieved from Henry C. Witelson Ophthalmic Pathology Registry, Canada and Hospital Luis S. Bulnes Pathology Registry, Mexico. Two independent, masked pathologists reviewed the H&E microslides. RESULTS: Forty-four cases were retrieved, 31 from Canada and 13 from Mexico. Cytoplasmic vacuoles were observed in 48% of the cases. Eighty-four percent of the cases were classified as poorly differentiated lesions. Of these, 75% had features similar to squamous cell carcinoma (SqCC), some with dyskeratosis (30%) and 7% resembled BCC. Solid growth pattern was seen in 26.2% of the cases and lobular growth pattern in 26.2%. Superficial spread resembling Bowen-like disease was observed in 33% of the cases, pagetoid features in 33% and comedocarcinoma in 31.8%. CONCLUSION: Sebaceous carcinoma presented as a poorly differentiated lesion in most cases of this series, which suggests a possibility of misdiagnosis because of its similarities to SqCC.

Fine needle aspiration biopsy to reestablish cell culture in an animal model of uveal melanoma / Biópsia aspirativa com agulha fina para restabelecer cultura celular em modelo animal de melanoma uveal

PURPOSE: To access the reliability of fine-needle aspiration biopsy in harvesting a sufficient amount of viable melanoma cells to establish a cell culture and maintain a melanoma cell line from an animal model of uveal melanoma. METHODS: For this study, fifteen male New Zealand albino rabbits had their right eye surgically inoculated with uveal melanoma cell line 92.1. The animals were immunosupressed with cyclosporine A using a dose schedule previously published. The animals were followed for 12 weeks. Intraocular tumor growth was monitored weekly by indirect ophthalmoscopy. After the fourth week, one animal was sacrificed per week preceded by fine-needle aspiration biopsy using a sharp 25-gauge, 1-inch long needle. Two separate aspirates were made from different areas of the tumor. Each aspirate was flushed to a separate cell culture media and sent for cell culture. The cells were frozen after two weeks when there were at least 1 million cells, which is enough to maintain a cell line. Cells were defrosted for HMB-45 immuno-stains to confirm the melanoma origin. RESULTS: Cell growth was observed from the samples harvested from 11 out of the 15 animals inoculated with uveal melanoma. All cell cultures, after defrost, immunoassayed positive for HMB-45. CONCLUSION: Fine needle aspiration biopsy seems to be a reliable method to harvest cells from solid intraocular melanomas in an animal model, to establish cell culture and to maintain a melanoma cell line.

OBJETIVO: Acessar a confiança da colheita de amostra celular suficiente através da biópsia aspirativa com agulha fina para estabelescer uma cultura celular e manter uma linhagem de células de melanoma a partir de uma modelo animal de melanoma uveal. MÉTODOS: Para esse estudo, 15 coelhos albinos da Nova Zelândia foram inoculados cirurgicamente com a linhagem celular 92.1 de melanoma uveal. Os animais foram imunosuprimidos com ciclosporina A usando uma dose previamente publicada. Os animais foram acompanhados por 12 semanas. O crescimento de tumor intraocular foi monitorado semanalmente pela oftalmoscopia indireta. Após a quarta semana, um animal foi sacrificado por semana, precedido pela biópsia aspirativa com agulha fina usando uma agulha de gauge 25 e comprimento 2,5 cm. Dois aspirados separados foram realizados a partir de áreas diferentes do tumor. Cada aspirado foi descarregado em um meio de cultura individual e enviado para cultura celular. As células foram congeladas após 2 semanas de cultura ou quando haviam pelo menos 1 milhão de células, o que é suficiente para manter uma linhagem celular. As células foram descongeladas para realizar imunocitoquímica com HMB-45 e confirmar sua origem melanocítica maligna. RESULTADOS: Crescimento celular foi observado nas amostras colhidas em 11 dos 15 animais inoculados com melanoma uveal. Todas as culturas celulares, após serem descongeladas, apresentaram imunoexpressão positiva para o HMB-45. CONCLUSÃO: Biópsia aspirativa com agulha fina parece ser um método confiável para colher células de tumores oculares sólidos em um modelo animal visando estabelecer e manter essa linhagem celular de melanoma.

Choroidal neovascularization associated with sympathetic ophthalmia: case report

Paciente com oftalmia simpática (OS) desenvolveu neovascularização coroidiana (NVC) na região macular do olho simpatizado. A biomicroscopia do segmento posterior do olho afetado revelou uma pequena lesão branco-amarelada, discretamente elevada, localizada na região temporal à fóvea. Uma banda fibrosa ligava o disco óptico à lesão foveal. A angiografia fluoresceínica, a lesão revelou hiperfluorescência progressiva, com impregnação e extravazamento tardio do corante, achados esses característicos de uma cicatriz fibrovascular. Apesar de intenso tratamento com medicação imunossupressora, a acuidade visual final do paciente foi de 20/400. Embora raramente associada à oftalmia simpática a neovascularização coroidiana pode ocorrer e comprometer o prognóstico visual de um olho já debilitado. A melhor opção para o tratamento da neovascularização coroidiana em casos de oftalmia simpática ainda não está determinada.

Achados histopatológicos em retinoblastoma / Histopathologic findings in retinoblastoma

OBJETIVO: Descrever e analisar os principais achados histopatológicos no retinoblastoma com ênfase na invasão de nervo óptico e túnicas oculares, correlacionando-os ao tratamento realizado. MÉTODOS: Vinte e oito olhos com diagnóstico de retinoblastoma tratados por enucleação na Universidade Federal de São Paulo entre dezembro de 2000 e outubro de 2002 foram submetidos à revisão histopatológica. Os dados clínicos incluiram idade, sexo, raça, lateralidade e tratamento realizado. Na revisão histopatológica foram avaliados neovascularização da íris e seio camerular, grau de diferenciação do tumor e invasão do nervo óptico e coróide de acordo com a classificação de Khelfaoui. RESULTADOS: De 27 pacientes, 13 (48,1 por cento) eram do sexo masculino e 14 (51,9 por cento) eram do sexo feminino, 16 (59,3 por cento) eram da raça branca, 5 (18,5 por cento) eram da raça amarela, 4 (14,8 por cento) eram pardos e 2 (7,4 por cento) eram negros. A média da idade dos pacientes foi de 22,7 meses, sendo 13 casos bilaterais e 14 casos unilaterais. Com relação ao tratamento utilizado, 13 (46,4 por cento) olhos foram submetidos a enucleação primária e 15 (53,6 por cento) tiveram tratamento prévio. Na avaliação histopatológica, 15 (53,6 por cento) tumores eram bem diferenciados. Neovascularização da íris e/ou seio camerular foram observados em 60,6 por cento e necrose e calcificação em 89,2 por cento dos casos. O envolvimento da coróide foi observado em 18 (64,2 por cento) dos casos (grau II e III) e a invasão de nervo óptico em 8 (28,5 por cento) (graus II, III e IV). Dos casos submetidos ao tratamento prévio 40 por cento tinham algum grau de invasão das túnicas oculares e apenas 6,67 por cento apresentavam simultaneamente invasão do nervo óptico e das túnicas oculares. Entretanto nos olhos que foram submetidos à enucleação primária 30,7 por cento apresentavam invasão das túnicas oculares e 53,8 por cento apresentavam simultaneamente invasão do nervo óptico e das túnicas oculares. CONCLUSAO: Neovascularização, necrose e calcificação foram achados mais comumente observados. A invasão do nervo óptico e coróide foram os dois fatores prognósticos mais importantes, encontrados em 28,5 por cento e 64,2 por cento dos casos respectivamente. Os casos tratados com enucleação primária apresentavam maior comprometimento ocular.

A evolução do mercado farmacêutico brasileiro no tratamento do glaucoma nos últimos 30 anos / Evolution of the Brazilian pharmaceutical market regarding glaucoma treatment during the last 30 years

OBJETIVO: Analisar as variações de custo das drogas para tratamento do glaucoma no mercado farmacêutico, nos últimos 30 anos, em intervalos de 10 anos. MÉTODOS: A partir dos Dicionários de Especialidades Farmacêuticas, dos anos de 1972, 1982, 1992 e 2002 nos quais foram anotadas as drogas utilizadas no tratamento do glaucoma, suas apresentações e laboratórios. Foram analisados os valores dos medicamentos no mercado brasileiro, nos diferentes anos, por meio do Guia Farmacêutico Brasíndice. Para análise dos dados, os preços foram convertidos para o dólar americano na época e estudada a relação percentual entre o preço dos medicamentos e o salário mínimo vigente na época, considerando-se como unidade de referência do produto os valores por mililitro, comprimido ou grama, dependendo da apresentação do fármaco. RESULTADOS: O número de laboratórios e medicações antiglaucomatosas variaram nestes últimos trinta anos. Drogas como a pilocarpina e acetazolamida continuam sendo utilizadas. Há predominância do uso de mióticos nos primeiros anos do estudo, e de beta-bloqueadores nos últimos anos. O custo médio das medicações disponíveis no mercado aumentou principalmente na última década. CONCLUSAO: O preço dos medicamentos antiglaucomatosos variou de forma considerável no período estudado, bem como o tipo de medicação usada no tratamento.