Hyaluronidase pharmacological properties and clinical application in ophthalmology

Abstract

Corneal diseases are the fourth leading cause of blindness in the world, accounting for approximately 5 % of cases. Existing methods of treatment in more than 30 % of cases do not have a full therapeutic effect and when the process is stopped, they end with a persistent violation of corneal transparency, a decrease or complete loss of visual functions. The lack of effective means that evidence-based restore corneal transparency determines the relevance of the search for modern drugs and ways to deliver them, the possibilities of enhancing the therapeutic effect. The possibilities of using hyaluronidase preparations in ophthalmology are considered based on the study of its biological and pharmacological properties. Enzyme catalyzes the breakdown of acid mucopolysaccharides including hyaluronic acid by cleavage of the glycosidic bond β(1→4), the biological effect is determined by the molecular weight of the resulting fragments: high-molecular fragments have antiangiogenic properties, increased ability to bind fibrinogen, anti-inflammatory and immunosuppressive effects, and low-molecular fragments have pro-inflammatory activity and promote angiogenesis. The barrier function of the cornea is provided by the features of its anatomical structure, while the features of its regeneration with the formation of turbidity are accompanied by overexpression and migration to the stroma of cytokines TGF-β and PDGF, activation of myofibroblasts and the formation of a fibroproliferative response. The high anti-inflammatory, immunomodulatory, regenerative and antifibrotic activity of hyaluronidase, the possibility of its effect on a complex pathophysiological cascade of destructive processes and minimization of the scarring process stimulate more extensive experimental and clinical studies on the development of new methods of treating ophthalmic diseases using hyaluronidase drugs.