glaucomaНациональный журнал ГлаукомаNational Journal glaucoma2078-41042311-6862Federal State Budgetary Institution of Science “Krasnov Research Institute of Eye Diseases”10.53432/2078-4104-2026-25-2-78-86glaucoma-631Research ArticleОБЗОРЫ ЛИТЕРАТУРЫLITERATURE REVIEWSСосудистая теория патогенеза глаукомной оптической нейропатии: сосудистая дисрегуляция, реология, глазное перфузионное давление, интраокулярная и системная гемодинамика. Сообщение 1Vascular theory of the pathogenesis of glaucomatous optic neuropathy: vascular dysregulation, rheology, ocular perfusion pressure, intraocular and systemic hemodynamics. Report 1https://orcid.org/0000-0002-6201-5051ЖазыбаевР. С.ZhazybaevR. S.

Жазыбаев Руслан Серикович, врач-офтальмолог консультативно-диагностического отделения 

680033, Хабаровск, ул. Тихоокеанская, 211 

ophthalmologist at the Consultative and Diagnostic Department 

211 Tikhookeanskaya St., Khabarovsk, 680033

naukakhvmntk@mail.ruhttps://orcid.org/0000-0003-0226-9014ЖировА. Л.ZhirovA. L.

врач-офтальмолог, заведующий консультативно-диагностическим отделением 

680033, Хабаровск, ул. Тихоокеанская, 211 

ophthalmologist, Head of the Consultative and Diagnostic Department 

211 Tikhookeanskaya St., Khabarovsk, 680033

https://orcid.org/0000-0002-2028-1140СорокинЕ. Л.SorokinE. L.

д.м.н., профессор, заместитель директора по научной работе, профессор кафедры общей и клинической хирургии

680033, Хабаровск, ул. Тихоокеанская, 211 

680000, Хабаровск, ул. Муравьёва-Амурского, 35 

Dr. Sci. (Med.), Professor, Deputy Head for Scientific Work, Professor at the Academic Department of General and Clinical Surgery

211 Tikhookeanskaya St., Khabarovsk, 680033

35 Muraviev-Amurskii St., Khabarovsk, 680000 

Хабаровский филиал ФГАУ «НМИЦ «МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова» Минздрава РоссииРоссияKhabarovsk branch of the S.N. Fedorov National Medical Research Center «MNTK «Eye Microsurgery»Russian FederationХабаровский филиал ФГАУ «НМИЦ «МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова» Минздрава России ; ФГБОУ ВО «Дальневосточный государственный медицинский университет» Минздрава РоссииРоссияKhabarovsk branch of the S.N. Fedorov National Medical Research Center «MNTK «Eye Microsurgery» ; Far-Eastern State Medical UniversityRussian Federation2026190520262527886Copyright © Жазыбаев Р.С., Жиров А.Л., Сорокин Е.Л., 20262026Жазыбаев Р.С., Жиров А.Л., Сорокин Е.Л.Zhazybaev R.S., Zhirov A.L., Sorokin E.L.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/631

Глаукомная оптическая нейропатия (ГОН) при первичной открытоугольной глаукоме (ПОУГ), включая глаукому нормального давления (ГНД), представляет собой многофакторное заболевание, в патогенезе которого значимая роль отводится сосудистым механизмам. Настоящая работа представляет обзор современных данных отечественной и зарубежной литературы, касающихся сосудистой теории ГОН. Обнаружено, что нарушение ауторегуляции глазного кровотока, вазоспазм, дисфункция эндотелия с повышенной продукцией эндотелина-1, снижение уровня оксида азота и изменение его метаболизма могут приводить к глаукомному поражению зрительного нерва даже при нормальных значениях внутриглазного давления. Рассматриваются особенности перфузионного давления, реологических свойств крови и системной гемодинамики с вариабельностью артериального давления как потенциально значимых факторов риска развития и прогрессирования ГОН. У пациентов с ГНД ряд исследований подтверждает снижение глазного кровотока и наличие микрососудистых нарушений, не зависящих от офтальмотонуса. Также обсуждаются данные об изменении вязкости крови, агрегации форменных элементов и их влиянии на микроциркуляцию в структурах глаза. Сделан вывод о высокой вероятности вовлечения сосудистых факторов в патогенез ГОН, что подчеркивает необходимость комплексного подхода к диагностике и лечению пациентов с ПОУГ.

Glaucomatous optic neuropathy (GON) in primary openangle glaucoma (POAG), including normal-tension glaucoma (NTG), is a multifactorial disease in which vascular mechanisms play a significant role. This article reviews current Russian and international literature on the vascular theory of GON. Impaired autoregulation of ocular blood flow, vasospasm, endothelial dysfunction with increased production of endothelin-1, reduced levels of nitric oxide and alterations in its metabolism may contribute to glaucomatous damage to the optic nerve even at normal intraocular pressure levels. The review examines the role of ocular perfusion pressure, hemorheological properties of blood, and systemic hemodynamics, including blood pressure variability, as potentially significant risk factors for the development and progression of GON. Several studies confirm reduced ocular blood flow and the presence of microvascular disturbances in patients with NTG independent of intraocular pressure. The paper also discusses changes in blood viscosity, aggregation of formed elements and their impact on microcirculation in ocular structures. The study concludes that there is a high likelihood of vascular involvement in the pathogenesis of GON, emphasizing the need for a comprehensive approach to the diagnosis and management of patients with POAG.

глаукомная оптическая нейропатияпервичная открытоугольная глаукомасосудистая теорияглазной кровотокперфузионное давлениеэндотелин-1оксид азотареология кровигемодинамикаglaucomatous optic neuropathyprimary open-angle glaucomavascular theoryocular blood flowperfusion pressureendothelin-1nitric oxideblood rheologyhemodynamicsReferencesНероев В.В., Михайлова Л.А., Малишевская Т.Н., Петров С.Ю., Филиппова О.М. Эпидемиология глаукомы в Российской Федерации. Российский офтальмологический журнал 2024;17(3):7-12. https://doi.org/10.21516/2072-0076-2024-17-3-7-12Neroev V.V., Mikhaylova L.A., Malishevskaya T.N., Petrov S.Yu., Filippova O.M. Glaucoma epidemiology in the Russian Federation. Russian Ophthalmological Journal 2024; 17(3):7-12. https://doi.org/10.21516/2072-0076-2024-17-3-7-12Мовсисян А.Б., Куроедов А.В., Архаров М.А. и др. Эпидемиологический анализ заболеваемости и распространенности первичной открытоугольной глаукомы в Российской Федерации. 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The authors declare that there are no conflicts of interest present.