ophthalmologyОфтальмологияOphthalmology in Russia1816-50952500-0845Ophthalmology10.18008/1816-5095-2023-1-24-32ophthalmology-2038Research ArticleОБЗОРЫREVIEWSБактериальный кератит. Часть 2. Актуальные аспекты леченияBacterial Keratitis. Part 2. Topical Aspects of TreatmentШиловскихО. В.ShilovskikhO. V.

Шиловских Олег Владимирович - кандидат медицинских наук, врач‑офтальмохирург, главный внештатный офтальмолог Свердловской области, генеральный директор

ул. Академика Бардина, 4а, Екатеринбург, 620149, Российская Федерация 

Shilovskikh Oleg V. - PhD, ophthalmic surgeon, chief freelance ophthalmologist of the Sverdlovsk region, general director

Academician Bardin str., 4A, Yekaterinburg, 620149, Russia 

https://orcid.org/0000-0002-2353-9610ПономаревВ. О.PonomarevV. O.

Пономарев Вячеслав Олегович - кандидат медицинских наук, врач‑офтальмохирург, заместитель генеральногодиректора по научно‑клинической работе

ул. Академика Бардина, 4а, Екатеринбург, 620149, Российская Федерация

Ponomarev Vyacheslav O. - PhD, ophthalmic surgeon, deputy general director for scientific and clinical work

Academician Bardin str., 4A, Yekaterinburg, 620149, Russia 

https://orcid.org/0000-0001-9569-5906КазайкинВ. Н.KazaykinV. N.

Казайкин Виктор Николаевич - доктор медицинских наук, врач‑офтальмохирург, ведущий научный сотрудник

ул. Академика Бардина, 4а, Екатеринбург, 620149, Российская Федерация

Kazaykin Viktor N.  - MD, ophthalmic surgeon, leading researcher

Academician Bardin str., 4A, Yekaterinburg, 620149, Russia 

https://orcid.org/0000-0001-8593-9364ТкаченкоК. А.TkachenkoK. A.

Ткаченко Константин Андреевич - врач‑офтальмолог

ул. Академика Бардина 4а, Екатеринбург, 620149, Российская Федерация

Tkachenko Konstantin A. - ophthalmologist

Academician Bardin str., 4A, Yekaterinburg, 620149, Russia 

kostyatka1996@gmail.comАО «Екатеринбургский центр МНТК “Микрохирургия глаза”» Министерства здравоохранения Российской ФедерацииРоссияEye Microsurgery Ekaterinburg CenterRussian Federation2023030420232012432Copyright © Шиловских О.В., Пономарев В.О., Казайкин В.Н., Ткаченко К.А., 20232023Шиловских О.В., Пономарев В.О., Казайкин В.Н., Ткаченко К.А.Shilovskikh O.V., Ponomarev V.O., Kazaykin V.N., Tkachenko K.A.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/2038

Бактериальный кератит (БК) представляет собой угрожающее состояние для анатомии и функции глазного яблока и требует незамедлительного комплекса лечебных мероприятий. Эффективное лечение, сохраняющее анатомический и функциональный результат органа зрения с применением различных нехирургических и хирургических методов, является основой лечения БК. Медикаментозная терапия включает в себя прежде всего массивную этиотропную терапию, которая представлена, как правило, антибиотиками широкого спектра действия, антисептиками и противовоспалительными препаратами. Данные комбинации позволяют конкурентно воздействовать на все звенья патологического процесса, проявляя аддитивный эффект. Перспективными нехирургическими средствами в борьбе с бактериальной инфекцией роговицы, в частности с резистентными микроорганизмами, являются квантовые точки, митомицин С, матриксные металлопротеиназы. В основе наиболее радикальных хирургических методов лечения лежит лечебная кератопластика, целью которой является иссечение инфекционного очага роговицы и восстановление ее прозрачности за счет трансплантации донорской роговичной ткани, но данный метод сопряжен с рядом недостатков и ограничений в выполнении. Аутоконъюнктивальная кератопластика является старейшим методом лечения прогрессирующих язв роговицы, и данный метод стоит рассматривать скорее как временный или подготовительный перед сквозной кератопластикой из-за отсутствия зрительных функций. Наименее радикальными и актуальными хирургическими методами лечения БК на сегодня являются кросслинкинг роговицы, микродиатермокоагуляции, применение цианоакрилатного клея, трансплантация амниотической мембраны. Расширение арсенала методов воздействия на микробный процесс роговицы и их дальнейшее изучение позволит быстро реагировать в ответ на бурно развивающуюся антибиотикорезистентность.

Bacterial keratitis (BC) is a threatening condition for the anatomy and function of the eyeball and requires an immediate complex of therapeutic measures. Effective treatment that preserves the anatomical and functional result of the organ of vision, including various non-surgical and surgical methods, is the basis for the treatment of CD. Drug therapy includes, first of all, massive etiotropic therapy, which is usually represented by broad-spectrum antibiotics, antiseptics and anti-inflammatory drugs. These combinations make it possible to competitively influence all links of the pathological process, showing an additive effect. Promising non-surgical means in the fight against bacterial infection of the cornea, in particular with resistant microorganisms, is the use of Quantum dots, Mitomycin C, Matrix metalloproteinases. The most radical surgical methods of treatment are based on therapeutic keratoplasty, the purpose of which is to excise the infectious focus of the cornea and restore its transparency through transplantation of donor corneal tissue, but this method has a number of disadvantages and limitations in its implementation. Autoconjunctival keratoplasty is the oldest method of treatment of progressive corneal ulcers and this method should be considered rather as temporary or preparatory before through keratoplasty, due to the lack of visual functions. The least radical and relevant surgical methods of CD treatment today are the use of Corneal Crosslinking, Microdiathermocoagulation, Cyanoacrylate glue, Amniotic membrane transplantation. The expansion of the arsenal of methods of influencing the microbial process of the cornea and their further study will allow for a quick response in response to the rapidly developing antibiotic resistance in the world.

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