Глаукома у беременных: особенности лечения

В обзоре представлена информация об особенностях, частоте встречаемости, патогенетическом механизме, вариантах консервативного, лазерного и хирургического лечения глаукомы у беременных. Цель работы — изучить на основе актуальной информации особенности ведения пациенток с глаукомой в период беременности. Глаукома — большая группа заболеваний глаза, характеризующаяся прогрессирующим снижением зрения вплоть до потери зрительных функций и атрофии зрительного нерва. Патология наиболее распространена среди населения старше 40 лет, но в связи с достижениями в области репродуктивных технологий, доступностью диагностических методик, высокой клинической осведомленностью увеличивается вероятность ведения офтальмологами глаукомы у беременных женщин. Повышенное внутриглазное давление у беременных становится все более часто встречаемой и, следовательно, актуальной проблемой. Наблюдается тенденция к увеличению числа беременных женщин, впервые столкнувшихся с повышением внутриглазного давления. К особенной категории пациентов относится уже выявленная патология в детском возрасте или же глаукома вторичная вследствие перенесенных ранее офтальмологических заболеваний или тяжелой соматической патологии. Все перечисленные категории встречаются в настоящее время и требуют тщательного мониторинга со стороны как офтальмолога, так и акушера-гинеколога. Доказательная база по антиглаукомным препаратам незначительна, имеются клинические эксперименты на животных, результаты которых не всегда можно переносить на человека, и ретроспективные исследования. В арсенале врача на данный момент имеется ряд препаратов, имеющих возможные побочные действия для плода, лазерное и хирургическое лечение. Стандартов оказания помощи не существует, поэтому каждый случай должен рассматриваться индивидуально с пониманием физиологии, механизма действия препаратов и их возможными эффектами. Таким образом, глаукома во время беременности и в период лактации представляет серьезную медицинскую проблему, решение которой лежит в плоскости междисциплинарной медицины.

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