ЭВОЛЮЦИЯ ПРЕДСТАВЛЕНИЙ О РОЛИ ВГД В ПРОГРЕССИРОВАНИИ ГЛАУКОМЫ (ОБЗОР)

Роль повышенного офтальмотонуса в прогрессировании ГОН была подчеркнута неоднократно. Впервые вопрос о роли повышенного внутриглазного давления (ВГД) как первопричины глаукомы возник в начале 60-х годов прошлого столетия. Однако вскоре эпидемиологические исследования по этому поводу подвергли сомнению роль ВГД как диагностического критерия глаукомы из-за относительно редкого обнаружения заболевания среди лиц с офтальмогипертензией и из-за частого выявления глаукомы при нормальном ВГД. Многоцентровые исследования, предпринятые с целью выяснить необходимость гипотензивной терапии в лечении глаукомы, показали важность снижения ВГД: было установлено, что снижение ВГД на 1 мм рт. ст. уменьшает риск развития глаукомы на 10-19%. Кроме того, оказалось, что скорость прогрессирования глаукомы весьма вариабельна и зависит не только от формы глаукомы, но и от других факторов, например, стадии заболевания и вида терапии. Согласно данным Шведского исследования, ГОН чаще прогрессировала у больных, получавших более агрессивное лечение: аргон-лазерную трабекулопластику и синустрабекулэктомию. Наиболее важным фактором риска прогрессирования ГОН, как показали все исследования, является возраст. По-прежнему, спорными остаются вопросы, касающиеся влияния флуктуаций ВГД, снижения ретробульбарного кровотока, гипотензивного лечения, на прогрессирование глаукомной оптиконейропатии. Несмотря на то, что последнее многоцентровое исследование UKGTS (2014) показало снижение скорости прогрессирования глаукомы у больных, применявших латанопрост, у высокого процента больных, не получавших лечения, отсутствовало прогрессирование заболевания. В связи с этим вопрос о роли ВГД, как главного пускового фактора в патогенезе глаукомы, остается открытым.

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