helmholtzeyeinstituteРоссийский офтальмологический журналRussian Ophthalmological Journal2072-00762587-5760Real time Publishers10.21516/2072-0076-2023-16-3-118-126helmholtzeyeinstitute-1309Research ArticleВ ПОМОЩЬ ПРАКТИЧЕСКОМУ ВРАЧУFOR OPHTHALMOLOGY PRACTITIONERSК вопросу о патогенетической классификации первичной закрытоугольной глаукомыOn the pathogenetic classification of primary angleclosure glaucomahttps://orcid.org/0000-0002-1148-5184БакунинаН. А.BakuninaN. A.

Наталья Александровна Бакунина - д-р мед. наук, заместитель генерального директора по лечебной работе, врач-офтальмолог

ул. Пречистенка, д. 29/14, Москва, 119034

Ленинский пр-т, д. 8, Москва, 119049

Natalia A. Bakunina - Dr. of Med. Sci., deputy general director for medical work, ophthalmologist

29/14, Prechistenka St., Moscow, 119034

8, Leninsky Ave, Moscow, 117049

nata-oko@mail.ruБалашоваЛ. М.BalashovaL. M.

Лариса Маратовна Балашова - д-р мед. наук, директор, заведующая отделом экспериментальной и клинической офтальмологии

ул. Пречистенка, д. 29/14, Москва, 119034

ул. Островитянова, д. 1, Москва, 117997

Larisa M. Balashova - Dr. of Med. Sci., head, head of the department of experimental and clinical ophthalmology

29/14, Prechistenka St., Moscow, 119034

1, Ostrovityanova St., Moscow, 117513

 

Некоммерческое партнерство «Международный научно-практический центр пролиферации тканей России»; ГКБ № 1 им. Н.И. ПироговаРоссияInternational Scientific and Practical Center for the Proliferation of Tissues of Russia; N.I. Pirogov City Clinical Hospital №1Russian FederationНекоммерческое партнерство «Международный научно-практический центр пролиферации тканей России»; ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииРоссияInternational Scientific and Practical Center for the Proliferation of Tissues of Russia; Russian N.I.Pirogov National Research Medical UniversityRussian Federation202311102023163118126Copyright © Бакунина Н.А., Балашова Л.М., 20232023Бакунина Н.А., Балашова Л.М.Bakunina N.A., Balashova L.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://roj.igb.ru/jour/article/view/1309

Цель работы - уточнение патогенетической классификации первичной закрытоугольной глаукомы (ПЗУГ) на основании генетических исследований и ретроспективного анализа.Материал и методы. Под наблюдением находилось 28 пациентов (44 глаза) в возрасте от 40 до 75 лет с различными формами начальной, развитой, далеко зашедшей и терминальной стадии ПЗУГ, а также смешанной глаукомы, прослеженных в динамике.Результаты. Найдены патогенетически значимые генетические полиморфизмы, ответственные за синехиогенез при хронической ПЗУГ. Клинико-генетический анализ ПЗУГ показал, что классификация, основанная на клиническом течении, механизмах закрытия радужно-роговичного угла (РРУ), распределении по стадиям первичного закрытия РРУ, степени выраженности патологического процесса и уровню внутриглазного давления, не учитывает генетические особенности пациентов с ПЗУГ, предрасположенность к которой заложена при рождении. При аппозиционном закрытии РРУ показана профилактическая лазерная иридотомия, тогда как при синехиальном закрытии РРУ профилактическая иридотомия может усугубить синехиогенез.Заключение. Предложена патогенетическая классификация ПЗУГ, учитывающая ее наследственно обусловленный характер, которую целесообразно использовать при выборе лечебной тактики.

Purpose: to clarify the pathogenetic classification of primary angle-closure glaucoma (PACG) based on genetic studies and retrospective analysis.Material and methods. 28 patients (44 eyes) aged 40 to 75 years with various forms of initial, advanced, advanced and terminal stages of PACG, as well as combined glaucoma, were observed.Results. Pathogenetically significant genetic polymorphisms responsible for synechiogenesis in chronic PACG have been found. Clinical and genetic analysis of PACG showed that the classification based on the clinical course, the mechanisms of closure of the iridocorneal angle (ICA), the distribution by stages of primary closure of the ICA, the severity of the pathological process and the level of intraocular pressure, fail to take into account the genetic characteristics of patients with PACG: these are predetermined at birth. In appositional closure of the ICA, preventive laser iridotomy is indicated, while in synechial closure, preventive iridotomy may aggravate synechiogenesis.Conclusion. A pathogenetic classification of PACG has been proposed, which takes account of its hereditary nature. This classification, is advisable to use when choosing a treatment tactics.

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