ophthalmologyОфтальмологияOphthalmology in Russia1816-50952500-0845Ophthalmology10.18008/1816-5095-2014-3-4-12ophthalmology-182Research ArticleОБЗОРЫREVIEWSГлаукома и диабетическая ретинопатия у пациентов с сахарным диабетом 2 типа. Обзор литературыGlaucoma and Diabetic Retinopathy in patients with diabetes mellitus type 2. Review.ВоробьеваИ. В.VorobyevaI. V.ЩербаковаЕ. В.ShherbakovaE. V.Кафедра офтальмологии ГБОУ ДПО РМАПО Минздрава РоссииРоссияDepartment of ophthalmology Russian Medical Academy of Postgraduate EducationRussian Federation201411102014113412Copyright © Воробьева И.В., Щербакова Е.В., 20142014Воробьева И.В., Щербакова Е.В.Vorobyeva I.V., Shherbakova E.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.ophthalmojournal.com/opht/article/view/182

Глаукома и диабетическая ретинопатия (ДР) занимают ведущее место среди заболеваний, приводящих к слепоте и инвалидности. Сочетание глаукомы и диабетической ретинопатии увеличивает степень тяжести заболеваний и делает прогноз менее благоприятным. Сходство патогенетических механизмов развития ДР и глаукомы позволяет предполагать возможность более частого развития первичной открытоугольной глаукомы среди лиц, страдающих сахарным диабетом 2 типа. Задача раннего выявления этих заболеваний является одной из наиболее сложных в офтальмологии. Современными методами диагностики ДР и глаукомы являются оптическая когерентная томография и Гейдельбергская ретинотомография, которые применяются для оценки динамики патологического процесса, эффективности хирургического и медикаментозного лечения. Оптическое сканирование диска зрительного нерва (ДЗН) и перипапиллярной сетчатки дает возможность оценить до 20 морфометрических параметров. Определение толщины СНВС в перипапиллярной зоне отражает состояние нервных волокон и степень их поражения. Показано, что при глаукоме происходит истончение СНВС и нейроретинального пояска. Наиболее информативными в ранней диагностике глаукомы считаются параметры ДЗН, характеризующие нейроретинальный поясок. ОКТ значительно расширяет диагностические возможности исследования структурных и морфологических изменений сетчатки в макулярной зоне у пациентов с ДР и ДМО. Измерение толщины сетчатки в макулярной области является ключевым в диагностике и решении вопроса о тактике лечения пациентов. Общепринятым методом терапии ДР в настоящее время является лазеркоагуляция сетчатки. Однако лазеркоагуляция оказалась недостаточно эффективна в качестве монотерапии у пациентов с диффузным и кистозным макулярным отеком. Для лечения диабетического макулярного отека (ДМО) и ДР считается целесообразным проводить лазеркоагуляцию сетчатки в комбинации с антиангиогенной терапией. Для лечения диабетического макулярного отека активно используется анти-VEGF препарат Ранибизумаб (Луцентис). Внимания заслуживает разработка алгоритма лечения пациентов с сочетанной патологией — глаукомой и диабетической ретинопатией. Сложной задачей является лечение неоваскулярной глаукомы у пациентов с сахарным диабетом 2 типа. Таким пациентам традиционно проводят панретинальную лазеркоагуляцию сетчатки. В последнее время в качестве дополнительного лечения неоваскулярной глаукомы используют анти-VEGF-препараты. Однако на сегодняшний день остается недостаточно изученным влияние антиангиогенного лечения на динамику клинико-морфологических показателей у больных с сочетанной патологией.

Glaucoma and diabetic retinopathy (DR) are the most frequent reasons of visual loss and disability. Combination of glaucoma and DR causes worse prognosis. Similarity of pathogenetic mechanisms of DR and glaucoma allows consideration of more frequent development of primary open-angle glaucoma among patients suffering diabetes mellitus. To reveal these diseases at the earliest stages is one of the most difficult ophthalmological problems. The contemporary methods of DR and glaucoma diagnostics are optical coherence tomography and Heidelberg retina tomography. They give an opportunity to estimate the dynamics of pathological process and the efficiency of surgical and pharmacological treatment. Optical scanning of an optic disk and peripapillary retina gives a chance to estimate up to 20 morphometric parameters. Determination of retinal nerve fiber layer (RNFL) thickness in peripapillary zone reflects a condition of nerve fibers and extent of their defeat. It is shown that in glaucoma there is a thinning of RNFL and a neuroretinal rim. In early diagnostics of glaucoma the parameters of optic disk characterizing neuroretinal rim are considered the most informative. OCT considerably expands diagnostic research possibilities of structural and morphological retinal changes in a macular zone in patients with DR and DME. Measurement of retinal thickness in macular area is a key point in diagnostics and tactics of treatment. The standard method of DR therapy is retinal laser coagulation. However, laser photocoagulation as monotherapy is not effective enough in patients with diffuse and cystoid macular edema. It is more reasonable to use retinal laser photocoagulation in combination with antiangiogenic therapy for treatment of the diabetic macular edema (DME) and DR. The special emphasis is put on development of treatment algorithm of combination of glaucoma and diabetic retinopathy. Therapy of neovascular glaucoma in patients with diabetes mellitus type 2 is a complex problem. Such patients traditionally get panretinal laser photocoagulation. Recently anti-VEGF-agents are used as additional therapy of neovascular glaucoma. However, nowadays the influence of antiangiogenic treatment on dynamics of clinical and morphological parameters in patients with the combined pathology is insufficiently investigated.

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