helmholtzeyeinstituteРоссийский офтальмологический журналRussian Ophthalmological Journal2072-00762587-5760Real time Publishers10.21516/2072-0076-2026-19-3-121-128helmholtzeyeinstitute-2236Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEWSТопические стероиды в офтальмологии. Часть 2. Сравнительный анализ, побочные эффекты и рекомендации по применениюTopical steroids in ophthalmology. Part 2. Comparative analysis, safety, and clinical guidelineshttps://orcid.org/0009-0009-8238-4741Абудайяк БахааА. М.Abudayyak BahaaA. M.

Мухаммад Абделькадер Абудайяк Бахаа — врач-офтальмолог, аспирант кафедры оториноларингологии и офтальмологии.

Университетская наб., д. 7/9, Санкт-Петербург, 199034

A.M. Abudayyak Bahaa — ophthalmologist, PhD student, chair of otorhinolaryngology and ophthalmology.

7/9, Universitetskaya emb., St. Petersburg, 199034

baha.jin@yandex.ruhttps://orcid.org/0000-0002-6393-1289НиколаенкоВ. П.NikolaenkoV. P.

Вадим Петрович Николаенко — д-р мед. наук, профессор кафедры оториноларингологии и офтальмологии Санкт-Петербургский ГУ, заместитель главного врача по офтальмологии Городская многопрофильная больница № 2.

Университетская наб., д. 7/9, Санкт-Петербург, 199034; Учебный пер., д. 5, Санкт-Петербург, 194354

Vadim P. Nikolaenko — Dr. of Med. Sci., professor, chair of otorhinolaryngology and ophthalmology St. Petersburg SU, deputy head doctor for ophthalmology CMH No. 2.

7/9, Universitetskaya emb., St. Petersburg, 199034; 5, Uchebnyy lane, St. Petersburg, 194354

ФГБОУ ВО «Санкт-Петербургский государственный университет»РоссияSt. Petersburg State UniversityRussian FederationФГБОУ ВО «Санкт-Петербургский государственный университет»; СПб ГБУЗ «Городская многопрофильная больница № 2»РоссияSt. Petersburg State University; City Multidisciplinary Hospital No. 2Russian Federation202628092026193121128Copyright © Абудайяк Бахаа А.М., Николаенко В.П., 20262026Абудайяк Бахаа А.М., Николаенко В.П.Abudayyak Bahaa A.M., Nikolaenko V.P.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/2236

Топические стероиды являются краеугольным камнем терапии воспалительных заболеваний переднего отрезка глаза и оказывают мощное противовоспалительное и иммуносупрессивное действие. В первой части обзора [РОЖ. 2026; 19 (2): 192–202] представлен комплексный сравнительный анализ фармакокинетики ключевых стероидов, применяемых в офтальмологической практике, — преднизолона, дексаметазона, фторметолона, гидрокортизона, лотепреднола, дифлупредната. В то же время их использование сопряжено с потенциальным риском развития серьезных нежелательных реакций, включая офтальмогипертензию, катаракту, замедление репаративных процессов и угнетение местного иммунитета. В связи с этим выбор оптимального препарата требует взвешенной оценки ожидаемой терапевтической эффективности и профиля безопасности в зависимости от конкретной клинической ситуации. Во 2-й части обзора основное внимание уделено сопоставлению клинической эффективности вышеуказанных стероидов, оценке связанных рисков и анализу патогенетических механизмов их развития, в первую очередь — стероидиндуцированной офтальмогипертензии. Обсуждаются дифференцированные подходы к назначению, учитывающие фармакологические свойства препаратов, локализацию и выраженность воспалительного процесса, а также индивидуальные факторы риска у пациента.

Topical steroids are a cornerstone in the management of inflammatory diseases of the anterior segment of the eye, providing potent anti-inflammatory and immunosuppressive effects. The first part of the review [ROJ. 2026; 19 (2): 192–202] presents a comprehensive comparative analysis of the pharmacokinetics of key steroids used in ophthalmology practice — prednisolone, dexamethasone, fluorometholone, hydrocortisone, loteprednol, and difluprednate. At the same time, their use is associated with a potential risk of developing serious adverse reactions, including ocular hypertension, cataracts, delayed reparative processes, and suppression of local immunity. Therefore, the choice of the optimal drug requires a balanced assessment of the expected therapeutic efficacy and safety profile depending on the specific clinical situation. Part 2 of the review focuses on comparing the clinical efficacy of the above-mentioned steroids, assessing the associated risks, and analyzing the pathogenetic mechanisms of their development, primarily steroid-induced ocular hypertension. Differentiated approaches to prescribing are discussed, considering the pharmacological properties of drugs, the localization and severity of the inflammatory process, as well as individual risk factors for the patient.

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