glaucomaНациональный журнал ГлаукомаNational Journal glaucoma2078-41042311-6862Federal State Budgetary Institution of Science “Krasnov Research Institute of Eye Diseases”glaucoma-194Research ArticleОБЗОР ЛИТЕРАТУРЫREVIEW OF LITERATUREСОСУДИСТАЯ ТЕОРИЯ ПАТОГЕНЕЗА ГЛАУКОМНОЙ ОПТИКОНЕЙРОПАТИИ: ФИЗИОЛОГИЧЕСКОЕ И ПАТОФИЗИОЛОГИЧЕСКОЕ ОБОСНОВАНИЕ. ЧАСТЬ 2VASCULAR THEORY OF THE GLAUCOMATOUS OPTIC NEUROPATHY PATHOGENESIS: PHYSIOLOGICAL AND PATHOPHYSIOLOGICAL RATIONALE. PART 2КурышеваН. И.KuryshevaN. I.

Курышева Наталия Ивановна, доктор медицинских наук, профессор, руководитель консультативно-диагностического отдела

123098, Москва, ул. Гамалеи, 15

Med.Sc.D., Professor, Head of the Diagnostic Department

15 Gamalei st., Moscow, 123098

e-natalia@list.ruЦентр офтальмологии ФМБА России, Клиническая больница № 86РоссияThe Ophthalmological Center of the Federal Medical and Biological Agency, Clinical Hospital No. 86Russian Federation20170604201816498109Copyright © Курышева Н.И., 20182018Курышева Н.И.Kurysheva N.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.glaucomajournal.ru/jour/article/view/194

В обзоре рассмотрены некоторые физиологические механизмы регуляции глазного кровотока и их нарушения в аспекте развития глаукомной оптиконейропатии. Приводится характеристика перфузионного глазного давления, его связи с внутриглазным и артериальным давлением с акцентом на роль их циркадианных колебаний. В литературе имеется много данных о том, что развитие глаукомы связано со снижением перфузионного давления. Освещены проблемы ауторегуляции кровотока глаза, а также роли нейрососудистого взаимодействия в регуляции глазного кровотока. Особое внимание уделено ретинальному и хориоидальному кровотоку в сравнительном аспекте и с акцентом на регуляцию этих двух источников кровоснабжения сетчатки и зрительного нерва. Рассмотрены такие фундаментальные причины нарушения глазного кровотока при глаукоме, как эндотелиальная дисфункция и первичная сосудистая дисрегуляция. Подчеркивается многообразие факторов, участвующих в поддержании постоянства глазного кровотока, что делает проблематичным выбор терапии рассмотренных расстройств. Рассмотрены основные механизмы, поддерживающие постоянство ауторегуляции глазного кровотока, а также причины нарушения нейроваскулярного взаимодействия. Таким образом, несмотря на присутствие всех классических механизмов регуляции глазного кровотока, физиология и патофизиология глазной гемоперфузии в значительной степени уникальна.

The review covers some of the physiological mechanisms of ocular blood flow regulation and disorders in the aspect of glaucomatous optic neuropathy development. The ocular perfusion pressure and its relations with intraocular and blood pressure, with emphasis on the role of circadian oscillations, have been studied. The studies have shown that glaucoma is associated with a reduction in the perfusion pressure. The problems of ocular blood flow autoregulation and neurovascular interactions’ role in the ocular blood flow regulation have been considered. Particular attention has been paid to the comparison of retinal and choroidal blood flow with an emphasis on the regulation of these two sources of blood supply to the retina and optic nerve. The fundamental causes of ocular blood flow disorder in glaucoma, such as endothelial dysfunction and primary vascular dysregulation, are discussed as well. The variety of factors involved in maintaining the constant ocular blood flow, making the choice of therapy problematic, has been noted. The main mechanisms that support the constancy of ocular blood flow autoregulation and causes of neurovascular interaction disorders have been describes. Thus, despite the presence of all the classic mechanisms of ocular blood flow regulation, physiology and pathophysiology of the eye hemoperfusion largely unique.

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The authors declare that there are no conflicts of interest present.