ophthalmologyОфтальмологияOphthalmology in Russia1816-50952500-0845Ophthalmology10.18008/1816-5095-2016-1-20-24ophthalmology-293Research ArticleОБЗОРЫREVIEWSНовые факторы, определяющие вариабельность циркадианных ритмов офтальмотонуса и показателя перфузионного давления у больных глаукомойThe new factors defining variability of circadian’s rhythms of intraocular and perfusion pressure of glaucoma patientsБарановаН. А.BaranovaN. A.

врач-кардиолог кардиологического отделения № 2 ФКУ «Медицинский учебно-научный клинический центр» МО РФ

cardiologist of «Medical Educational Scientific Clinical Center» Ministry of Defence Russian Federation,, Mandryka Clinical Research and Training Medical Center8A Bolshaya Olenya st., Moscow, 107014, Russian Federation

nataliabaranova86@gmail.comКуроедовА. В.KuroyedovA. V.

д.м.н., начальник офтальмологического отделения ФКУ «Медицинский учебно-научный клинический центр» МО РФ, +7 (909) 644 1111

MD, Head of Ophthalmology Department of «Medical Educational Scientific Clinical Center» Ministry of Defence Russian Federation, Mandryka Clinical Research and Training Medical Center8A Bolshaya Olenya st., Moscow, 107014, Russian Federation,  +7 (909) 644 1111

akuroedov@hotmail.comОвчинниковЮ. В.OvchinnikovYu. V.

д.м.н., главный терапевт Министерства обороны РФ

MD, Chief physician of the Russian Ministry of Defense,, Mandryka Clinical Research and Training Medical Center8A Bolshaya Olenya st., Moscow, 107014, Russian Federation

ovchinnikov.munkc@mail.ruФКУ «Медицинский учебно-научный клинический центр им. П. В. Мандрыка» Министерства Обороны Российской Федерации, ул. Большая Оленья, 8А, Москва, 107014, Российская ФедерацияРоссияMandryka Clinical Research and Training Medical Center8A Bolshaya Olenya st., Moscow, Russian Federation, 107014Russian Federation2016040420161312024Copyright © Баранова Н.А., Куроедов А.В., Овчинников Ю.В., 20162016Баранова Н.А., Куроедов А.В., Овчинников Ю.В.Baranova N.A., Kuroyedov A.V., Ovchinnikov Y.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/293

В настоящее время наиболее научно обоснованными местными факторами риска развития и прогрессирования глаукомы считают повышенный уровень внутриглазного давления (ВГД) и его неустойчивость в течение суток, что обусловлено местными гидромеханическими нарушениями. Вместе с тем, не прекращается изучение других факторов, влияющих на изменения уровней офтальмотонуса. Например, было установлено, что свет является одним из самых главных факторов, влияющих на интенсивность циклических колебаний различных биологических процессов, в том числе, и колебаний уровня ВГД. В то же время, глаукома может приводить к различным нарушениям сна по причине несоответствия между циклами «сон-бодрствование». Одной из причин этого является гибель ганглиозных клеток сетчатки и их аксонов. Такие повреждения опосредованно приводят к снижению выработки меланопсина — зрительного пигмента, который находится в сетчатке, но не принимает участие в зрительном процессе, однако обеспечивает реализацию циркадианных ритмов «сон-бодрствование» и опосредованно влияет на супрессию эпифизарного мелатонина. Вероятнее всего, мелатонин играет защитную роль при возникновении и прогрессировании глаукомы, защищая клетки сетчатки от воздействия свободных радикалов и оказывая непосредственное влияние на уровень ВГД. Изменение уровня офтальмотонуса и, в частности, его понижение, происходит под влиянием мелатонина. В связи с этим, глаукома, как заболевание, при котором происходит гибель клеток сетчатки, в том числе, и вырабатывающих меланопсин, дает возможность для изучения нарушений циклических ритмов. Мелатонин также действует и на такие доказанные факторы риска и прогрессирования глаукомы, как артериальная гипертензия и сахарный диабет. Опубликованы отдельные результаты о применении агонистов мелатонина в эксперименте и клинической практике. Так, при их использовании, помимо местного и системного гипотензивного действия, нормализуется сон пациентов. Данные о влиянии мелатонина на прямое и косвенное снижение уровня офтальмотонуса, а также его нейропротекторное действие и уменьшение проявления депрессии может быть в дальнейшем использовано при комплексном лечении пациентов с глаукомой.

Currently, the most scientifically based local risk and progressive factors are elevated levels of intraocular pressure and its instability during the day, caused by local hydromechanical disturbances. However, the other factors affecting the circadian changes of intraocular pressure levels are still evaluated. It was found that light is one of the most important factors affecting the intensity of the cyclical fluctuations of various biological processes, including, and fluctuations of intraocular pressure. At the same time, glaucoma can lead to a variety of sleep disorders, due to a mismatch between cycles «sleep-wake». One if this reason is the death of retinal ganglion cells and their axons. Such damage indirectly lead to a decrease in production of the pigment melanopsin, which is located in the retina. It is not involved in the visual process, but ensures the implementation of circadian rhythms «sleep-wake» and mediated suppression of epiphyseal melatonin. Most likely, melatonin plays a protective role in the occurrence and progression of glaucoma, protecting retinal cells against free radicals and has a direct impact on the intraocular pressure level. Several studies have shown that the circadian change in intraocular pressure levels, and in particular, its substantial reduction, is influenced by melatonin. In this regard, glaucoma is a disease in which the death of retinal cells, including producing melanopsin, a unique opportunity to study violations of cyclic rhythms. Melatonin acts on such established risk factors and progression of glaucoma as hypertension and diabetes. There are published results of the use of melatonin agonists in the experiment and clinical practice. So, in addition to local and systemic hypotensive action, normalizes sleep patients. Data about the melatonin’s effects on the direct and indirect reduction of intraocular pressure, neuroprotective effects and reducing symptoms of depression can be used in the complex treatment of patients with glaucoma in future.

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