Воспаление и фильтрующая хирургия глаукомы. Часть 2: значение противовоспалительной терапии в хирургии глаукомы

Многолетнее применение местных гипотензивных препаратов, особенно содержащих консерванты, у па- циентов с глаукомой приводит к значительным изменениям глазной поверхности. Патогенетическую основу этих изменений составляют снижение слезопродукции и стабильности слезной пленки, обеднение популяции бокаловидных клеток, повышенная экспрессия провоспалительных цитокинов, дисрегуляция факторов роста, а также клеточная инфильтрация покровных тканей глаза. Развивающееся при этом субклиническое воспаление обусловливает непредсказуемое заживление послеоперационной раны. Эти изменения являются ключевым патогенетическим звеном в цепи событий, приводящих к раннему субконъюнктивальному фиброзу, что, в свою очередь, становится основной причиной неудачи фильтрующих операций. В представленном обзоре проведен анализ современных стратегий улучшения отдаленных результатов фильтрующих операций. Рассмотрены основные аспекты комплексной предоперационной подготовки глазной поверхности, включающей использование щадящих лекарственных режимов, антифлогистических и увлажняющих средств. Также проведен анализ современных подходов к фармакологической модуляции процессов заживления послеоперационной раны с особым акцентом на применение противовоспалительной терапии.

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