ophthalmologyОфтальмологияOphthalmology in Russia1816-50952500-0845Ophthalmology10.18008/1816-5095-2015-1-16-23ophthalmology-220Research ArticleОБЗОРЫREVIEWSМорфо-функциональные критерии в оценке эффективности нейропротекторной терапии при глаукомной оптической нейропатии
Morphological functional criteria of neuroprotective therapy efficacy in glaucomatous optic neuropathyДаньЦзиньDanTszinjindan1004@gmail.comФедеральное государственное бюджетное учреждение «Научно-исследовательский институт глазных болезней», ул. Россолимо, д. 11A, 119021, Москва, РоссияРоссияScientific Research Institute of Eye Diseases, 11A, Rossolimo Str. Moscow, Russia, 119021Russian Federation2015310320151211623Copyright © Дань Ц., 20152015Дань Ц.Dan T.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/220

Данная статья обосновывает применение электрофизиологических методов исследования для выявления ранних глаукомных изменений, глаз с риском прогрессирования и объективных улучшений на фоне нейропротекторного лечения. Описаны основные патогенетические этапы глаукомного процесса, патогенез и многофакторность глаукомной оптической нейропатии (ГОН). Рассмотрены главные пусковые факторы ГОН — механический и сосудистый. Освещены принципы нейропротекторной терапии и группы нейропротекторных препаратов, действие прямых и непрямых нейропротекторов. Дано обоснование измерения уровня роговично-компенсированного ВГД для подбора нейропротекторной терапии и контроля ее эффективности. Подробно рассказано об основных средствах нейропротекторной терапии глаукомы (агонисты NMDA-рецепторов, антиоксиданты, пептиды и блокаторы кальциевых каналов). Приведено описание структурных и функциональных повреждений при глаукоме и методов их выявления. Более подробно рассказано о дефектах полей зрения при глаукоме и их частотности, а также о наиболее информативных и специфичных исследованиях для их выявления. Дана сравнительная характеристика конфокальной лазерной офтальмоскопии, оптической когерентной томографии и сканирующей лазерной поляриметрии как ведущих методик, позволяющих исследовать диск зрительного нерва и слой нервных волокон сетчатки с целью диагностики и мониторинга глаукомы, подозрения на данное заболевание и офтальмогипертензии. Отдельно упомянуты психофизические методы исследования и описываются три наиболее чувствительных и специфичных для ГОН электрофизиологических метода исследования: паттерн-электроретинография, мультифокальная электроретинография и мультифокальные зрительные вызванные потенциалы. 

Electrophysiological tests may be used to detect early glaucomatous changes and glaucoma progression risk and to monitor treatment efficacy. Most important pathogenic aspects of glaucomatous process, pathogenesis and multifactorial nature of glaucomatous optic neuropathy are described. Major triggers of glaucomatous optic neuropathy are mechanical and vascular. Principles of neuroprotective therapy, neuroprotective drugs, and mechanisms of action of direct and indirect neuroprotective agents are presented. IOPcc is a basis for neuroprotective therapy selection and its efficacy monitoring. Amongst neuroprotective drugs, NMDA agonists, antioxidants, peptides, and calcium channel blockers are of special importance. Structural damage and functional deficiency (e.g., visual field loss) in glaucoma and the most informative and accurate methods of their detection are characterized. Confocal laser microscopy, optical coherence tomography, and scanning laser polarimetry are compared. These techniques are used to study optic nerve head and retinal nerve fiber layer. They are proposed as diagnostic and monitoring tools for glaucoma, glaucoma suspicion, and ocular hypertension. The most sensitive and specific electrophysiological tests for glaucomatous optic neuropathy are pattern electroretinography, multfocal electroretinography, and multifocal visually evoked potentials. 

глаукомаэлектрофизиологические методы исследованиянейропротекторная терапияконфокальная лазерная офтальмоскопияоптическая когерентная томографиясканирующая лазерная поляриметрияпаттерн-электроретинографиямультифокальная электроретинографиямультифglaucomaelectrophysiological studiesneuroprotectionconfocal laser microscopyoptic coherence tomographyscanning laser polarimetrypattern electroretinogrammultifocal electroretinogrammultifocal visual evoked potentials.ReferencesKurysheva N. I. [Glaucomatous optic neuropathy]. Glaukomnaja opticheskaja nejropatija. Мoscow, MEDpress-inform; 2006. (in Russ.).Kurysheva N. I. [Glaucomatous optic neuropathy]. Glaukomnaja opticheskaja nejropatija. Мoscow, MEDpress-inform; 2006. (in Russ.).Nesterov A. P. [Glaucoma]. Glaukoma. Мoscow, MIA, 2008. (in Russ.).Nesterov A. P. [Glaucoma]. Glaukoma. Мoscow, MIA, 2008. (in Russ.).Avetisov S.E., Egorov E.A., Moshetova L.K., Neroev V.V., Takhchidi Kh.P. [Ophthalmology: National guidelines]. 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The authors declare that there are no conflicts of interest present.