ophthalmologyОфтальмологияOphthalmology in Russia1816-50952500-0845Ophthalmology10.18008/1816-5095-2017-1-5-11ophthalmology-347Research ArticleОБЗОРЫREVIEWSСовременная концепция борьбы с избыточным рубцеванием после фистулизирующей антиглаукомной операции. Факторы риска и антиметаболические препаратыModern Methods of Controlling Wound Healing after Fistulizing Glaucoma Surgery. Risk Factors and AntimetabolitesПетровС. Ю.PetrovS. Yu.

к.м.н., ведущий научный сотрудник,

ул. Россолимо, 11а, Москва, 119021

PhD, Leading Researcher,

Rossolimo str. 11a, Moscow, 119021

glaucomatosis@gmail.comФГБНУ «Научно-исследовательский институт глазных болезней»РоссияScientific Research Institute of Eye DiseasesRussian Federation201729032017141511Copyright © Петров С.Ю., 20172017Петров С.Ю.Petrov S.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/347

В статье рассмотрен современный подход к борьбе с избыточным рубцеванием после фистулизирующей хирургии глаукомы. Приводится классификация степеней рефрактерности и факторы риска избыточного рубцевания. Дается описание различных способов применения представленных в практике антиметаболических препаратов (5-фторурацил, митомицин С) у пациентов с разной степенью риска рубцевания. Описан опыт применения и результаты исследований эффективности стероидных и нестероидных противовоспалительных препаратов. Большое внимание уделено новым стратегиям регуляции ранозаживления после фильтрующей хирургии глаукомы, направленным на улучшение исходов этих операций. Приведены характеристики и описания механизмов действия препаратов, модулирующих ранозаживление посредством воздействия на цитоскелет, таких как ингибиторы Rho-киназы и противоопухолевые препараты из класса таксанов. Дается подробное описание влияния различных стратегий на послеоперационное заживление раны с помощью регулирующих этот процесс факторов роста, цитокинов и протеиназ: ингибирование трансформирующего фактора роста β и эффектора, расположенного далее по пути передачи сигнала от ТФР-β (фактор роста соединительной ткани, ФРСТ), который влияет на продукцию компонентов внеклеточного матрикса, последующее формирование рубца и, в отличие от многих других групп препаратов, представленных в статье, считающегося «мишенью» для терапевтической модуляции фиброза и рубцевания. Затем ингибирование сосудистого эндотелиального фактора роста (VEGF), опосредованно влияющего на фиброз через ангиогенный эффект и, предположительно, оказывающего прямое воздействие на активность фибробластов; ингибирование провоспалительного плацентарного фактора роста PIGF, улучшающее исходы хирургии благодаря увеличению площади и продолжительности функционирования фильтрационной подушки в сочетании с уменьшением выраженности признаков послеоперационного ангиогенеза, фиброза и воспаления; а также применение интерферона-α (ИФН-α), представляющего собой цитокин с противофиброзными свойствами. Кратко рассматриваются менее распространенные и изученные способы регулирования избыточного рубцевания в зоне операции, такие как подавление активности матриксных металлопротеиназ и применение амниотической мембраны.

The article describes modern approaches to controlling wound healing after fistulizing glaucoma surgery. It provides a classification of refractory glaucoma degrees and summarizes risk factors for excessive scarring. Author describes various applications of widely administered in clinical practice antimetabolites (5 fluorouracil, mitomycin C) in patients with different degrees of excessive wound healing risk. The review also recounts international experience of steroidal and nonsteroidal anti-inflammatory drug use and their efficacy research study results. Much attention is given to new strategies of wound healing regulation after fistulizing glaucoma surgery, aimed at enhancing its results. The article describes characteristics and modes of action of medicinal agents effecting the cytoskeleton, such as Rho-kinase inhibitors and taxane anticancer agents. A detailed account of modes of effecting wound healing through regulating the process growth factors, proteinases and cytokines is also given. Possible strategies include antifibrotic cytokine interferon-α application and inhibiting the following agents: transforming growth factor β; connective tissue growth factor (CTGF), that controls extracellular matrix components production and cicatrical tissue formation; vascular endothelial growth factor (VEGF), that indirectly influences fibrotic activity through its angiogenic effect and also has a supposed direct effect on fibroblast activity; proinflammatory placental growth factor (PIGF), that increases bleb area size and its survival time, and decreases postoperative angiogenesis, inflammation and fibrosis intensity. The last part of the article gives a brief report on less widespread and researched methods of wound healing regulation, such as suppressing the activity of matrix metalloproteinases and amniotic membrane application.

глаукомахирургия глаукомыфильтрационная подушкаизбыточное рубцеваниеантиметаболические препараты5-фторурацилмитомицин Сингибиторы Rho-киназытаксанытрансформирующий фактор роста βфактор роста соединительной тканисосудистый эндотелиальный фактор ростаплацентарный фактор ростаинтерферон-αматриксные металлопротеиназыамниотическая мембранаglaucomaglaucoma surgeryblebwound healingantimetabolites5-fluorouracilmitomycin CRho-kinase inhibitorstaxane anticancer agentsinterferon-αtransforming growth factor βconnective tissue growth factorvascular endothelial growth factorplacental growth factormatrix metalloproteinasesamniotic membrane applicationReferencesGurtner G.C., Werner S., Barrandon Y., Longaker M.T. Wound repair and regeneration. Nature. 2008;453(7193):314-321. DOI:10.1038/nature07039.Gurtner G.C., Werner S., Barrandon Y., Longaker M.T. Wound repair and regeneration. Nature. 2008;453(7193):314-321. DOI:10.1038/nature07039.Cheung J.C., Wright M.M., Murali S., Pederson J.E. 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The authors declare that there are no conflicts of interest present.