helmholtzeyeinstituteРоссийский офтальмологический журналRussian Ophthalmological Journal2072-00762587-5760Real time Publishers10.21516/2072-0076-2020-13-2-78-82helmholtzeyeinstitute-434Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEWSГипотензивная терапия глаукомы и нейропротекцияHypotensive glaucoma therapy and neuroprotectionЖуравлеваА. Н.ZhuravlevaA. N.

Анастасия Николаевна Журавлева — канд. мед. наук, научный сотрудник отдела глаукомы

ул. Садовая-Черногрязская, д. 14/19, Москва,105062

Anastasia N. Zhuravleva — Cand. of Med. Sci., researcher of the glaucoma department

14/19, Sadovaya-Chernogryazskaya St., Moscow, 105062

zh.eye@mail.ruЗуеваМ. В.ZuevaM. V.

Марина Владимировна Зуева — д-р биол. наук, профессор, начальник отдела клинической физиологии зрения им. С.В. Кравкова

ул. Садовая-Черногрязская, д. 14/19, Москва,105062

Marina V. Zueva — Dr of Biol. Sci., Professor, head of the department of clinical physiology of vision named after S.V. Kravkov

14/19, Sadovaya-Chernogryazskaya St., Moscow, 105062

visionlab@yandex.ruФГБУ «НМИЦ глазных болезней им. Гельмгольца» Минздрава РоссииРоссияHelmholtz National Medical Research Center of Eye DiseasesRussian Federation2020270520201327882Copyright © Журавлева А.Н., Зуева М.В., 20202020Журавлева А.Н., Зуева М.В.Zhuravleva A.N., Zueva M.V.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/434

Большинство современных гипотензивных препаратов, применяемых в лечении первичной открытоугольной глаукомы, оказывают непрямой нейропротекторный эффект не только за счет снижения внутриглазного давления (ВГД), но и из-за стимулирующего воздействия на естественные метаболические процессы в глазу. Исследователи и клиницисты сегодня следуют стратегии компенсации ВГД с самых ранних стадий глаукомной оптической нейропатии (ГОН), независимо от того, какое лекарственное средство (генерическое или оригинальное) и в каком сочетании основных действующих веществ снижает ВГД. Вопрос о необходимости нейропротекторной терапии в клинической практике в основном встает либо в далеко зашедших стадиях ГОН, либо при прогрессирующей потере зрительных функций. Однако, учитывая многофакторный характер заболевания, чрезвычайно важно вовремя, начиная с самых ранних стадий, подключить нейропротекторное лечение. Электрофизиологические и морфометрические исследования могут обеспечить объективный мониторинг нейропротекторной терапии. В целях повышения эффективности лечения в дополнение к гипотензивной терапии необходимо раннее использование прямых нейропротекторов, направленных на защиту от окислительного стресса, эксайтотоксичности и воздействующих на другие молекулярные механизмы глаукомы, для блокирования первичных событий нейродегенерации.

Most modern antihypertensive drugs used in the treatment of primary open-angle glaucoma have an indirect neuroprotective effect not only because they reduce intraocular pressure (IOP), but also because of a stimulating effect on the natural metabolic processes in the eye. Researchers and clinicians today follow the strategy of compensating IOP, starting from the earliest stages of glaucomatous optic neuropathy (GON), regardless of which drug (generic or original) reduces IOP and which combination of the main active substances this drug has. The need for neuroprotective therapy in clinical practice mainly appears either in the far advanced stages or in cases of progressive loss of visual functions. However, given the multifactorial nature of GON, it is extremely important to add neuroprotective treatment in time, starting from the early stages. Electrophysiological and morphometric studies can provide objective monitoring of neuroprotective therapy. In order to increase the effectiveness of treatment, hypotensive therapy should be supplemented by early use of direct neuroprotectors targeted at oxidative stress, and excitotoxicity and affecting other molecular mechanisms of glaucoma so as the primary events of neurodegeneration could be blocked.

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