glaucomaНациональный журнал ГлаукомаNational Journal glaucoma2078-41042311-6862Federal State Budgetary Institution of Science “Krasnov Research Institute of Eye Diseases”10.53432/2078-4104-2022-21-4-79-88glaucoma-419Research ArticleОБЗОРЫ ЛИТЕРАТУРЫLITERATURE REVIEWSФакторы развития рефрактерной формы первичной открытоугольной глаукомы (часть 1)Factors in the development of refractory primary open-angle glaucoma (part 1)ФоминН. Е.FominN. E.

Фомин Николай Евгеньевич - врач-офтальмолог ЦВКГ им. П.В. Мандрыка Минобороны РФ; ассистент кафедры офтальмологии РНИМУ им. Н.И. Пирогова Минздрава РФ.

107014, Москва, ул. Б. Оленья, 8А; 117997, Москва, ул. Островитянова, 1

Ophthalmologist, Mandryka Central Military Clinical Hospital; Assistant Professor at the Academic Department of Ophthalmology, Pirogov State National Research Medical University.

8A Bolshaya Olenya St., Moscow, 107014; 1 Ostrovityanova St., Moscow, 117997

nikolay.fomin2608@yandex.ruКуроедовА. В.KuroyedovA. V.

Доктор медицинских наук, профессор кафедры офтальмологии РНИМУ им. Н.И. Пирогова Минздрава РФ; начальник офтальмологического центра ЦВКГ им. П.В. Мандрыка Минобороны РФ.

117997, Москва, ул. Островитянова 1; 107014, Москва, ул. Б. Оленья, 8А

Dr. Sci. (Med.), Head of the Ophthalmology Сenter, Mandryka Central Military Clinical Hospital; Professor at the Academic Department of Ophthalmology, Pirogov State National Research Medical University.

8A Bolshaya Olenya St., Moscow, 107014; 1 Ostrovityanova St., Moscow, 117997

Центральный военный клинический госпиталь им. П.В. Мандрыка Минобороны РФ; Российский национальный исследовательский медицинский университет имени Н. И. Пирогова Минздрава РФРоссияMandryka Central Military Clinical Hospital; Pirogov State National Research Medical UniversityRussian FederationРоссийский национальный исследовательский медицинский университет имени Н. И. Пирогова Минздрава РФ; Центральный военный клинический госпиталь им. П.В. Мандрыка Минобороны РФРоссияMandryka Central Military Clinical Hospital; Pirogov State National Research Medical UniversityRussian Federation2022251120222147988Copyright © Фомин Н.Е., Куроедов А.В., 20222022Фомин Н.Е., Куроедов А.В.Fomin N.E., Kuroyedov A.V.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/419

Первичная открытоугольная глаукома (ПОУГ) — одна из значимых медико-социальных проблем современного общества. Развитие ее рефрактерности усугубляет патологический процесс и приводит к неизбежной слепоте. Несмотря на то, что ПОУГ составляет до 80% среди всех случаев заболеваний глаукомой, проблема формирования ее  рефрактерности  рассмотрена в различных отечественных и зарубежных источниках недостаточно подробно. В статье представлен обзор основных офтальмологических факторов, которые способствуют изменениям различных структур глазного яблока и ускоряют формирование рефрактерных форм ПОУГ. Так, одной из причин является генетическая предрасположенность к развитию ПОУГ. Стоит отметить, что у 60% пациентов с положительным семейным анамнезом риск развития ПОУГ возрастает в 10 раз (при первой степени родства). Также дополнительными факторами развития рефрактерной формы ПОУГ являются реактивный синдром и травматизация трабекулы при проведении лазерной хирургии. Важно подчеркнуть, что риск развития и прогрессирования ПОУГ у пациентов   с наследственной предрасположенностью значительно выше, при этом назначение ряда лечебных мероприятий может явиться причиной формирования лекарственной резистентности. Генотипирование является перспективным научно-практическим направлением, благодаря которому представляется возможным прогнозировать фармакологический ответ на применение определенного лекарственного средства и индивидуально подбирать подходящую терапию согласно генотипу пациента. Такой подход позволит предотвратить ряд осложнений и сделать прогноз течение заболевания более контролируемым.

Primary open-angle glaucoma (POAG) is one of the most significant medico-social problems in the modern society. The development of its refractoriness aggravates the pathological process and inevitably leads to blindness. Despite the fact that this form accounts for up  to  80%  of all glaucoma cases, the problem of POAG refractoriness has not been considered in sufficient detail in either Russian or foreign sources. The article presents an overview of the main ophthalmic factors that contribute to changes in various structures of the eyeball and accelerate the formation of refractory forms of POAG. One of the reasons for that is a genetic predisposition to the  development of POAG.  It is worth noting that in 60% of patients with    a family history of glaucoma, the risk of developing POAG increases by 10 times (among the first-degree relatives).

Additional factors in the development of the refractory form of POAG are the reactive syndrome and during laser surgery. It is important to emphasize that the risk of development and progression of POAG in patients with     a hereditary predisposition is much higher, while indicating a number of therapeutic measures may lead to drug resistance. Genotyping is a promising scientific and practical direction of research, allowing prediction of the pharmacological response to a particular drug and individual selection of the appropriate therapy according to the patient's genotype. This approach could help prevent a number of complications and improve the accuracy of disease prognosis.

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