Современные представления о молекулярных основах этиопатогенеза первичной открытоугольной глаукомы

Abstract

The article presents a review of literature on the pathogenesis of primary open angle glaucoma. Most of these theories boil down to three basic concepts: mechanical (hydromechanical), vascular and metabolic disorders theory. The formation of components of extra-cellular matrix (collagen, proteoglycans, molecules of cell adhesion) is disordered in case of primary open-angle glaucoma. It is assumed that the change in the elasticity and firmness of the fibrous capsule of the eye due to an abnormal acceleration of the natural aging processes as a result in metabolism alterations of collagen – the main structural protein of the sclera is of importance for the development of glaucomatous process besides the pathology of the trabecular network and the lattice membrane. The metabolic theory explains an increase in intraocular pressure and a development of glaucomatous optic neuropathy as an impact of peptides, free radicals, lipids and others on the drainage ocular structures, retina and optic nerve. The paper considers the disorders of vascular autoregulation and local vasospasm, disturbances in the cerebral hemodynamics, a low perfusion pressure in the vessels of the optic nerve and choroid related to systemic arterial hypotension, increase in vascular resistance and the elevated blood viscosity as probable causes of ischemia. The role of mitochondria, immune disorders in the glaucoma process is of importance. Cytokines released during immune and inflammatory reactions are investigated in terms of immune disorders. Some authors consider glaucoma as a group of diseases developing on an associated apoptosis stimulation. Despite the great advances in an understanding of the pathogenesis of primary open angle glaucoma, the identification of factors contributing to the development of glaucomatous process, a unique theory of etiopathogenesis glaucomatous process does not exist at the present time.