ophthalmologyОфтальмологияOphthalmology in Russia1816-50952500-0845Ophthalmology10.18008/1816-5095-2017-2-113-119ophthalmology-371Research ArticleОБЗОРЫREVIEWSСОВРЕМЕННЫЕ ТЕНДЕНЦИИ В ЛЕЧЕНИИ УВЕИТОВMODERN OPPORTUNITIES IN UVEITIS TREATMENTКрахмалеваД. А.KrakhmalevaD. A.

Крахмалева Дарья  Александровна  — младший  научный  сотрудник.

Krakhmaleva Dar'ya A. — Research Assistant.

11 A,B, Rossolimo St.,  Moscow, 119021

eskess@mail.ruПивинЕ. А.PivinE. A.

Пивин  Евгений Анатольевич — кандидат медицинских наук, научный сотрудник.

Ул. Россолимо, 11 А,Б, Москва, 119021

Pivin Evgenii A. — Research Officer, PhD.

11 A,B, Rossolimo St.,  Moscow, 119021

ТруфановС. В.TrufanovS. V.

Труфанов Сергей Владимирович — доктор медицинских наук старший научный сотрудник.

Ул. Россолимо, 11 А,Б, Москва, 119021

Trufanov Sergej V. — Senior Research Officer, MD.

11 A,B, Rossolimo St.,  Moscow, 119021

МаложенС. А.MalozhenS. A.

Маложен Сергей Андреевич — доктор медицинских наук, старший  научный  сотрудник.

Ул. Россолимо, 11 А,Б, Москва, 119021

Malozhen Sergej A. — Senior Research Officer, MD.

11 A,B, Rossolimo St.,  Moscow, 119021

ФГБНУ «НИИ глазных болезней»РоссияResearch Institute of Eye DiseasesRussian Federation201702072017142113119Copyright © Крахмалева Д.А., Пивин Е.А., Труфанов С.В., Маложен С.А., 20172017Крахмалева Д.А., Пивин Е.А., Труфанов С.В., Маложен С.А.Krakhmaleva D.A., Pivin E.A., Trufanov S.V., Malozhen S.A.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/371

Увеиты  представляют собой  гетерогенную  группу воспалительных заболеваний  сосудистой  оболочки  глаза   и прилежащих структур.  Патофизиология увеитов  может  быть  различной. Подход к  лечению  инфекционного  и неинфекционного  увеита, маскарадного  синдрома   также  отличается, однако  коррекция  иммунных нарушений  при  увеитах  любой  этиологии  должна  занимать ведущее   место.   При инфекционной  этиологии  лечение   основывается на  эрадикации  патогенного   организма с  применением  адекватной  патогенетически  ориентированной антимикробной   терапии.   Терапия  неинфекционного  увеита основана на  подавлении  локального иммунного ответа  и, в зависимости от активности воспалительного процесса,  может варьировать от местного  лечения  до системной  иммуносупрессии с применением кортикостероидов или стероидсберегающих иммуномодуляторных терапевтических агентов. Основные группы иммуносупрессивных  препаратов представлены анкилирующими  агентами, антиметаболитами, ингибиторами  Т-клеток  и так  называемыми  биологическими модуляторами  иммунного ответа. Их применение помогает  сократить количество и интенсивность рецидивов, уменьшить  число осложнений, снизить дозу кортикостероидов или заменить их при развитии  резистентности и побочных эффектов. Альтернативными способами лечения  увеитов могут служить эфферентные методы  гемокоррекции. Наиболее  часто  применяется плазмаферез,  действие которого  основано  на удалении  плазмы  с растворенными в ней медиаторами воспаления, иммунными комплексами, антителами, экзои эндотоксинами. Лечение  должно  быть патогенетически ориентировано и локализовано в пораженной ткани, чтобы оптимизировать соотношение эффективность/побочный эффект. Однако зачастую добиться  этого не удается, поэтому продолжается поиск новых средств, способных подавить  активность воспалительного процесса, предотвратить иммуноопосредованное повреждение тканей  и снижение  остроты  зрения  с минимальным  количеством побочных эффектов.

Uveitis is a heterogeneous group  of inflammatory  diseases of the  choroid  and  adjacent structures. The pathophysiology of uveitis may be different. The treatment approach of infectious and non-infectious uveitis or masquerade syndrome is also different, but the correction of immune  disorders of any uveitis should play a leading role.  Infectious etiology requires the  pathogen eradication with adequate antimicrobial therapy. Therapy of noninfectious  uveitis based on the suppression of the local immune response. Depending on the activit y of the inflammatory process it may require  system or topical anti-inflammatory and/or immunosuppressive treatment with corticosteroids or immunomodulatory therapeutic agents. The main groups  of drugs are presented with the immunosuppressive alkylating agents,  corticosteroids, antimetabolites, T-cell inhibitors  and  biological modulators of the  immune  response. They can reduce the amount  and intensit y of recurrence, the number of complications, decrease  the dose  of corticosteroids or even replace them  in the  case of the  development of side effects and resistance. An alternative uveitis treatment is extracorporal efferent-quantum hemocorrection methods. The most  commonly used  is plasmapheresis based on the removal of plasma  with dissolved mediators of inflammation,  immune complexes, antibodies, exoand endotoxins.  Treatment should  be  pathogenetically oriented  and  localized to  the  affected tissue in order  to  maximize the  ratio  of efficacy / side effect. Often, however, this can’t be achieved.  So the  search continues to develop new therapies for use  in uveitis that  aim  to  suppress inflammatory  activit y,  prevent  accumulation of damage, and  preserve  visual function  for  patients with the minimum possible  side effects.

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