Топические стероиды в офтальмологии. Часть 2. Сравнительный анализ, побочные эффекты и рекомендации по применению

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.

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