ophthalmologyОфтальмологияOphthalmology in Russia1816-50952500-0845Ophthalmology10.18008/1816-5095-2016-2-62-68ophthalmology-301Research ArticleОБЗОРЫREVIEWSКорнеосклеральная оболочка глаза: возможности оценки биомеханических свойств в норме и при патологииThe corneoscleral shell of the eye: potentials of assessing biomechanical parameters in normal and pathological conditionsИомдинаЕ. Н.IomdinaE. N.

дмн, профессор ФГБУ «Московский научно-исследовательский институт глазных болезней им. Гельмгольца» Минздрава России, ул. Садовая-Черногрязская, 14 / 19, Москва, 105062, Российская Федерация

MD, professor, Moscow Helmholtz Research Institute of Eye Diseases; 14 / 19 Sadovaya-Chernogryazskaya str., Moscow, 105062, Russian Federation

glaucomatosis@gmail.comПетровС. Ю.PetrovS. Yu.

ведущий научный сотрудник отдела глаукомы ФГБНУ «НИИ глазных болезней», ФГБНУ «НИИ глазных болезней», 119021, Российская Федерация, Москва, ул. Россолимо, д. 11а

PhD, The Scientific Research Institute of Eye Diseases, 11a Rossolimo str., Moscow, 119021, Russian Federation, +7‑916‑607‑93‑26

glaucomatosis@gmail.comАнтоновА. А.АntonovA. A.

ведущий научный сотрудник отдела глаукомы ФГБНУ «НИИ глазных болезней», 119021, Российская Федерация, Москва, ул. Россолимо, д. 11а.

PhD, Senior Research Officer, The Scientific Research Institute of Eye Diseases, 11a Rossolimo str., Moscow, 119021, Russian Federation,

niigb.antonov@gmail.comНовиковИ. А.NovikovI. A.

старший научный сотрудник лаборатории фундаментальных исследований ФГБНУ «НИИ глазных болезней», 119021, Российская Федерация, Москва, ул. Россолимо, д. 11а

Senior Research Officer, The Scientific Research Institute of Eye Diseases, 11a Rossolimo str., Moscow, 119021, Russian Federation

toiaia@rambler.ruПахомоваИ. А.PahomovaI. A.

аспирант ФГБНУ «НИИ глазных болезней», 119021, Российская Федерация, Москва, ул. Россолимо, д. 11а

Postgraduate, The Scientific Research Institute of Eye Diseases, 11a Rossolimo str., Moscow, 119021, Russian Federation

nata_050487@mail.ruАрчаковА. Ю.ArchakovA. Y.

аспирант ФГБУ «Московский научно-исследовательский институт глазных болезней им. Гельмгольца» Минздрава России, ул. Садовая-Черногрязская, 14 / 19, Москва, 105062, Российская Федерация

Postgraduate, Moscow Helmholtz Research Institute of Eye Diseases; 14 / 19 Sadovaya-Chernogryazskaya str., Moscow, 105062, Russian Federation

ФГБУ «Московский научно-исследовательский институт глазных болезней им. Гельмгольца» Минздрава России, ул. Садовая-Черногрязская, 14 / 19, Москва, 105062, Российская ФедерацияРоссияMoscow Helmholtz Research Institute of Eye Diseases; Sadovaya-Chernogryazskaya str. 14 / 19, Moscow, Russian Federation, 105062Russian FederationФедеральное государственное бюджетное научное учреждение Научно-исследовательский институт глазных болезней, Россолимо, 11A,Б, Москва, 119021, Российская ФедерацияРоссияThe Scientific Research Institute of Eye Diseases, 11a Rossolimo str., Moscow, 119021 Russian FederationRussian Federation2016040720161326268Copyright © Иомдина Е.Н., Петров С.Ю., Антонов А.А., Новиков И.А., Пахомова И.А., Арчаков А.Ю., 20162016Иомдина Е.Н., Петров С.Ю., Антонов А.А., Новиков И.А., Пахомова И.А., Арчаков А.Ю.Iomdina E.N., Petrov S.Y., Аntonov A.A., Novikov I.A., Pahomova I.A., Archakov A.Y.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/301

В статье представлены современные методы оценки биомеханических свойств корнеосклеральной оболочки глаза, предназначенные, как для исследования патогенеза различных офтальмопатологий, так и для практического использования в клинических условиях. Показана диагностическая значимость биомеханических показателей роговицы и склеры при оценке риска осложнений и определения эффективности кераторефракционных вмешательств, для диагностики и прогноза течения кератоконуса, прогрессирующей миопии, глаукомного поражения. В клинической практике достаточно широкое применение нашел анализатор глазного ответа — Ocular Response Analyzer (ORA), позволяющий оценить два параметра, характеризующих упруго-вязкие свойства роговицы — корнеальный гистерезис (КГ) и фактор резистентности роговицы (ФРР). Снижение КГ и ФРР отмечено после эксимерлазерной хирургии, особенно у пациентов с наличием регресса рефракционного эффекта, а также при кератоконусе, что дает основание использовать эти биомеханические показатели как дополнительные диагностические критерии в оценке состояния роговицы. В то же время показано, что данные ORA отражают биомеханический отклик на воздействие воздушного импульса не только роговицы, но корнеосклеральной капсулы в целом. По-видимому, с этим связано снижение КГ у детей с прогрессирующей миопией и ослабленной опорной функцией склеры, а также у взрослых с глаукомным поражением. Высказано предположение, что низкое значение КГ является результатом ремоделирования соединительнотканного матрикса корнеосклеральной оболочки глаза и может являться независимым фактором, свидетельствующим о риске прогрессирования глаукомного процесса. Снижение КГ при первичной открытоугольной глаукоме (сравнение показателей проводилось при компенсированном внутриглазном давлении) происходит параллельно с развитием патологических структурных изменений диска зрительного нерва, ухудшением полей зрения, что свидетельствует о специфичности и чувствительности этого показателя. Дальнейшее совершенствование и внедрение в клиническую практику бесконтактных неинвазивных методов оценки биомеханического статуса роговицы и склеры позволит улучшить диагностику различных патологий глаза, в той или иной степени связанных с нарушением опорных свойств корнеосклеральной оболочки глаза.

The paper reviews modern methods of evaluating the biomechanical properties of the corneoscleral shell of the eye that can be used both in the studies of the pathogenesis of various ophthalmic pathologies and in clinical practice. The biomechanical parameters of the cornea and the sclera have been shown to be diagnostically significant in assessing the risk of complications and the effectiveness of keratorefractive interventions, in the diagnosis and the prognosis of keratoconus, progressive myopia, or glaucoma. In clinical practice, a special device, Ocular Response Analyzer (ORA), has been used on a large scale. The analyzer is used to assess two parameters that characterize viscoelastic properties of the cornea — corneal hysteresis (CH) and corneal resistance factor (CRF). Reduced levels of CH and CRF have been noted after eximer laser surgery, especially that administered to patients who demonstrate a regression in the refraction effect or suffer from keratoconus. This fact justifies the use of these biomechanical parameters as additional diagnostic criteria in the evaluation of the state of the cornea. At the same time, ORA data are shown to reflect the biomechanical response to the impact of the air pulse not only from the cornea alone but also from the whole corneoscleral capsule. This is probably the cause of reduced CH in children with progressive myopia and a weakened supportive function of the sclera, as well as such reduction in glaucomatous adult patients. It is hypothesized that a low CH value is a result of remodeling of the connective tissue matrix of the corneoscleral shell of the eye and can be an independent factor testifying to a risk of glaucoma progression. Reduced CH in primary open-angle glaucoma occurs in parallel with the development of pathological structural changes of the optic disc, and deterioration of visual fields, which is an evidence of a specific character and sensitivity of this parameter. The values were compared under compensated intraocular pressure. Further improvement of noncontact and noninvasive techniques of the assessment of the biomechanical status of the cornea and the sclera and their introduction into clinical practice will improve the diagnosis of various eye pathologies in any way related to disorders of the supporting functions of the corneoscleral shell.

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