ophthalmologyОфтальмологияOphthalmology in Russia1816-50952500-0845Ophthalmology10.18008/1816-5095-2015-4-9-17ophthalmology-271Research ArticleОБЗОРЫREVIEWSСовременная концепция избыточного рубцевания в хирургии глаукомыThe modern concept of wound healing in glaucoma surgeryПетровС. Ю.PetrovS. Yu.

ул. Россолимо, д. 11а, Москва, 119021

11A,B, Rossolimo St., Moscow, 11902

glaucomatosis@gmail.comСафоноваД. М.SafonovaD. M.

ул. Россолимо, д. 11а, Москва, 119021

11A,B, Rossolimo St., Moscow, 11902

Федеральное государственное бюджетное научное учреждение Научно-исследовательский институт глазных болезнейРоссияResearch Institute of Eye DiseasesRussian Federation201508012016124917Copyright © Петров С.Ю., Сафонова Д.М., 20162016Петров С.Ю., Сафонова Д.М.Petrov S.Y., Safonova D.M.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/271

Послеоперационное рубцевание является одним из ключевых факторов, определяющих успех фильтрующей хирургии в отдаленном периоде. Рубцевание тканей — физиологический ответ организма, направленный на восстановление тканевой структуры и функций посредством ряда взаимосвязанных клеточных процессов. Хирургическая травма способствует проникновению белков плазмы крови в зону фильтрации внутриглазной жидкости, запуску каскада реакций свертывания и активации комплемента. Процесс заживления раны делится на три взаимосвязанных этапа: воспаление, пролиферация и ремодуляция рубца. Воспаление считается защитным ответом на повреждение, позволяющим сохранить структурную целостность и клеточные функции тканей. Оно характеризуется поступлением в рану нейтрофилов и моноцитов. Нейтрофилы фагоцитируют инфицирующие рану бактерии и очищают зону повреждения. Макрофаги способствуют санации раневой полости, участвуют в фагоцитозе и вырабатывают ряд факторов, необходимых для формирования новой ткани. В ходе пролиферативной фазы происходит реэпителизация и формирование грануляционной ткани с высвобождением факторов роста, стимулирующих образование внеклеточного матрикса и пролиферацию фибробластов. Завершающий этап заживления раны характеризуется ремоделированием матрикса с очищением раны благодаря одновременному синтезу и разрушению компонентов матрикса, дифференцировкой клеток, их созреванием и апоптозом. Нарушение апоптоза удлиняет срок жизни фибробластов и способствует избыточному рубцеванию. Считается, что ключевую роль в рубцевании различных тканей играют три фактора роста: трансформирующий фактор роста β, фактор роста соединительной ткани, сосудистый эндотелиальный фактор роста. Представлен обзор их изоформ, роли в процессе рубцевания и возможности их ингибирования в лечебных целях. Матриксные металлопротеиназы представляют собой семейство белков, которые способны расщеплять компоненты внеклеточного матрикса. Предположительно, они играют ключевую роль в контрактуре фильтрационной подушки за счет своего влияния на фибробласты теноновой капсулы. Селективное ингибирование металлопротеиназ после фильтрующей хирургии глаукомы оказывает превентивное действие на стягивание фильтрационной подушки в послеоперационном периоде, позволяя уменьшить вероятность неудачного исхода.

Post-operative wound healing is one of the key-factors, defining success of filtrating surgery in late post-operative period. Wound healing is a physiological response directed at tissue structure reconstruction and function restoration, performed by several interacting cellular pathways. Surgical trauma leads to plasma proteins penetration to the filtration zone, as well as coagulation pathway and complement activation. The process of wound healing can be divided into three interconnected stages: inflammation, proliferation and scar remodeling. Inflammation is a protective response to tissue damage, that helps preserve its structure and cellular functions. It is characterized by neutrophil and monocyte arrival at the wound site. Neutrophils phagocytose the wound infecting bacteria and clean the wound site. Macrofages aid wound cleansing, participate in phagocytosis and produce a range of factors, necessary for new tissue formation. Proliferation stage consists of reepithelization and granulation tissue formation, which is accompanied by growth factors release. The growth factors stimulate the extracellular matrix formation and fibroblast proliferation. The last stage of the wound healing process is characterized by extracellular matrix remodeling with wound debridement achieved by a simultaneous synthesis and destruction of certain matrix components, cell differentiation, maturation and apoptosis. Apoptosis disturbance prolongs the fibroblast cell life and promotes excessive scarring. Three growth factors are thought to play a pivotal role in tissue healing and scarring transforming growth factor β, connective tissue growth factor and vascular endothelial growth factor. The article contains a review of their isoforms, role in wound healing and the possibility of their inhibition to alter the process. Matrix metalloproteinases are a protein family that can digest extracellular matrix components. Due to their influence on the tenon’s capsule fibroblasts, they supposedly play a key role in bleb contraction. Metalloproteinases selective inhibition after glaucoma filtration surgery can serve as a preventive measure against postoperative bleb constriction, which in turn enhances the likelihood of postoperative success.

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