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},
"code": "H18.6",
"name": "Кератоконус",
"icd_name": "Кератоконус",
"gender": 0,
"age_min": 10,
"age_max": 40,
"cause": [
"0"
],
"periodicity": 1,
"slug": "h18.6_keratokonus",
"lead": "дегенеративное невоспалительное заболевание глаз, при котором роговица из-за структурных изменений истончается и принимает коническую форму в отличие от нормальной – сферической",
"description": "<p><span id=\"docs-internal-guid-95343cb5-7fff-6753-944d-deaa148f44b6\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Кератоконус – это тяжелое заболевание глаза, проявляющееся прогрессирующей деформации роговицы, которая принимает коническую форму.</span></span></p>",
"etiology": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Точная причина развития заболевания не установлена. Считается, что к развитию кератоконуса может привести: генетический фактор (наследственные болезни); воздействие радиационного излучения, ультрафиолета и запыленность помещений; микротравмы и болезни глаза, в частности роговицы (кератоеонъюнктивит, кератиты, пигментная ретинопатия); приемом стероидных гормонов; использование неверно подобранных контактных линз. эксимерлазерная коррекция зрения. Также была обнаружена взаимосвязь между кератоконусом и экземой, бронхиальной астмой, атопическим дерматитом, синдромом Марфана и Дауна и др. При заболевании в деформированной роговице происходят многочисленные биохимические нарушения, уменьшается объем коллагена, белка, кератин-сульфата. В роговице из-за понижения антиоксидантной активности формируются деструктивные иероксинитриты и альдегиды. Нарушения в первую очередь происходят на базальной мембране или в месте перехода в стому. Под давлением влаги передней камеры роговица выпячивается и в дальнейшем мутнеет. </span></p>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Патофизиологическая цепочка кератоконуса включает:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #181d21; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">изменения структуры стромы;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #181d21; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">дисбаланс между провоспалительными и антивоспалительными факторами;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #181d21; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">оксидативный стресс (повреждение клеток из-за окисления) и клеточная гиперчувствительность, вызванные дисбалансом ферментов, повреждающих внеклеточный матрикс, и ферментов-антагонистов.</span></p>\r\n</li>\r\n</ul>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Наиболее достоверными и информативными методами диагностики являются:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Скиаскопия – метод начальной диагностики кератоконуса. Это исследование предполагает использование светового луча, который направляется врачом на радужку, отражается от ее поверхности и образует светлые полосы на роговичном слое, которые должны располагаться под определенным углом. При деформации роговицы угол искривления этих полос отклоняется от показателей нормы, что свидетельствует о развитии кератоконуса.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Рефрактометрия – это вспомогательный метод диагностики, при помощи которого подтверждается факт деформации роговичного слоя путем обнаружения измененного астигматизма и миопии. Такой способ диагностики основывается на использовании луча света, который при кератоконусе изменяет силу преломления и фокусировку после прохождения роговицы.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Кератометрия – дает возможность постановки предварительного диагноза. Исследование заключается в изучении роговичного слоя на предмет его искривления. Его проведение осуществляется при помощи специального прибора или на компьютерном кератометре. Последний вариант более точен, так как позволяет предельно точно высчитывать искривление роговицы, сопоставляя текущие показатели с общепринятыми нормами.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Картированная пахиметрия – с высокой долей вероятности позволяет выявить патологию на ранних стадиях развития или даже при первых тревожных признаках. В ходе исследования применяется специальный прибор, позволяющий определить участок деформации в самом начале ее формирования.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Оптическая компьютерная топография – метод схож с предыдущим, но более точен, так как предполагает использование экспертного оборудования, которое считывает данные о строении роговицы, анализирует их, выделяя основные признаки возникновения деформации роговичного слоя.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Диафаноскопия – при исследовании учитываются особенности тени на роговичном слое: при кератоконусе она принимает клиновидную форму.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Оптическая когерентная томография – используется в ходе выполнения клинических исследований.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Исследование роговицы путем биомикроскопии, конфокальной и эндотелиальной микроскопии. Эти методы предназначены для раннего выявления заболевания, так как с их помощью определяются патологические изменения на клеточном уровне.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Одним из методов выявления кератоконуса является щелевая лампа, но с ее помощью обнаружить заболевание можно только на поздних стадиях развития болезни. Если при осмотре с использованием щелевой лампы врач видит на поверхностном слое роговицы кольцо Флейшнера (коричнево-желтая окантовка, формирующаяся из солей железа), можно говорить о развитии кератоконуса.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">С учетом характера течения кератоконуса (быстроты прогрессирования, склонности к рецидивам) лечение может быть дифференцированным: безоперационным или хирургическим.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Консервативное лечение кератоконуса заключается в коррекции зрения с помощью полужестких линз (в центре - жестких, на периферии – мягких), которые как бы вдавливают конус роговицы. В начальных стадиях, особенно при непрогрессирующем, стабильном течении кератоконуса, может быть эффективна и очковая коррекция. Назначаются курсы витаминотерапии, тканевой терапии, иммуномодуляторов и антиоксидантов; глазные капли (таурин), субконъюнктивальные и парабульбарные инъекции АТФ, метилэтилпиридинола. При кератоконусе эффективно проведение физиотерапии (магнитотерапии, фонофореза с токоферолом и др. процедур).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При развитии острого кератоконуса требуется неотложная помощь: закапывание в глаз мидриатиков (мезатона, мидриацила и др.), наложение давящей повязки на глаз с целью профилактики перфорации роговицы.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Сравнительно новым, отлично зарекомендовавшим себя методом консервативного лечения кератоконуса является роговичный кросс-линкинг, заключающийся в удалении поверхностного эпителия с роговицы, закапывании на нее раствора рибофлавина и последующем облучении УФ-лучами. Данная процедура позволяет укрепить роговицу, повысить ее устойчивость к деформации, остановить развитие или достичь регресса кератоконуса. После проведения роговичного кросс-линкинга становится возможной обычная очковая и контактная коррекция мягкими линзами.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">На начальной стадии кератоконуса при достаточной толщине роговой оболочки возможно проведение эксимерлазерной процедуры (ФРК+ФТК), позволяющей скорректировать астигматизм, повысить остроту зрения, укрепить передние слои роговицы и замедлить прогрессирование кератэктазии.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В некоторых случаях с целью уменьшения корнеальной деформации применяется термокератопластика – нанесение коагулятором на периферию роговицы точеных аппликаций, которые позволяют добиться уплощения роговицы.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">В хирургии кератоконуса используется метод имплантации роговичных колец. Стромальные (роговичные) кольца изменяют поверхность роговицы, нормализуют рефракцию и стабилизируют роговицу.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Классической операцией при кератоконусе является сквозная или послойная кератопластика, предполагающая удаление собственной роговицы и имплантацию на ее место донорского трансплантата. Кератопластика сопровождается практически 100%-ным приживлением трансплантата и позволяет откорректировать остроту зрения до 0,9-1,0 примерно в 90% случаев. Сквозная кератопластика может быть предпринята даже в терминальной стадии кератоконуса.</span></p>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Чтобы не подвергать себя опасности возникновения кератоконуса, следует придерживаться таких правил:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">носите солнцезащитные очки при ярком свете;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">не трите часто глаза, иначе есть риск получить микро-травмы глазного яблока;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">при пыльных работах используйте специальные защитные очки;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">выбирайте контактные линзы и очки только с врачом-офтальмологом;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">проходите ежегодное обследование в клинике;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">давайте отдых глазам, не перенапрягайте их;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">внимательно следите за состоянием здоровья и при первых признаках болезни обоих глаз или одного глазного яблока обращайтесь за консультацией в офтальмологический центр.</span></li>\r\n</ul>\r\n<p> </p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">К числу общих и наиболее распространенных клинических признаков кератоконуса относятся:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">прогрессирующее снижение зрения;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">повышенная утомляемость органов зрения;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">зуд и чувство жжения на слизистых оболочках глазного яблока;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">слезоточивость, особенно при ярком свете;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">деформация и помутнение роговичного слоя при осмотре у окулиста;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">двоение в глазах;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">пониженная концентрация внимания;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">искажение объектов в поле зрения;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">необходимость в частой смене очков и контактных линз;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">снижение работоспособности, связанное с ухудшением зрения;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">в редких случаях – полная слепота.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В числе прочих клинических признаков наиболее распространенными являются неприятные и болезненные ощущения в глазах, их повышенная утомляемость, слезоточивость. Такие симптомы проявляются ухудшением зрения, вследствие которого пациенту приходится прищуриваться и часто инстинктивно тереть глаза.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Теми же причинами обусловлено возникновение головных болей, которые связаны со снижением внимания, работоспособности, способности концентрироваться на чем-либо. У больных кератоконусом стремительное ухудшение зрения часто сменяется длительным застоем в развитии болезни.</span></p>",
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"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Основная причина иридоциклита – нарушение гематоофтальмологического барьера. Это преграда между кровью питающих сосудов и светопроводящими средами глаза. Ее роль выполняет эндотелий капилляров, который работает по принципу фильтра, задерживая крупные молекулы, токсичные соединения, иммунные комплексы, антигены – вирусы, бактерии, грибки. Под влиянием внешних или внутренних факторов защитная функция барьера нарушается, и любая инфекция, аутоантигены и аутоиммунные комплексы по сосудам проникают в радужку и цилиарное тело, формируя очаг воспаления.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Среди внешних факторов, способных нарушить барьер, выделяют:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">травмы глазного яблока – проникающие ранения, ушибы, инородные тела;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ожоги роговицы – термические, химические, радиационные;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">наличие ранее занесенной глазной инфекции – кератиты, ячмень, блефарит;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">хирургические операции – в результате инфицирования или при повышенной чувствительности на само вмешательство.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Чаще всего иридоциклит является признаком серьезных внутренних нарушений – аутоиммунных, эндокринных, обменных, инфекционных. Причиной возникновения могут стать:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ревматические поражения тканей – причина переднего увеита в 50% случаев;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">другие аутоиммунные поражения соединительной ткани – саркоидоз, спондилоартроз;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">внутренние очаги вирусного поражения – корь, герпес, стафилококковая, стрептококковая инфекция;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">бактериальные заболевания – сифилис, гонорея, тиф;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">протозойные возбудители – хламидии, малярии, токсоплазмы;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">хронические инфекции различной этиологии – отиты, синуситы, циститы;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">аллергические реакции.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Косвенно спровоцировать воспаление сосудистой оболочки глаза могут стресс и постоянное зрительное напряжение, синдром сухого глаза, недостаток витаминов в пище, переохлаждение и общее снижение иммунитета</span></p>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Механизм появления иридоциклита связан с распространением инфекции в организме и общим состоянии иммунитета.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При внедрении патогенных микроорганизмов иммунная система быстро включает функцию защиты: неспецифические факторы (слизистую, лимфоузлы и др.), интерферон и воспалительную реакцию.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Особая роль в иммунном ответе на инфекцию отводится специфическим реакциям антител и сенсибилизированных (чувствительных) лимфоцитов на антигены. Они локализуют и обезвреживают антигены. При этом в процесс вовлекаются лимфоидные клетки глаза.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Так как инфекция передаётся через кровоток, сосудистая оболочка глаза является мишенью для иммунных реакций, своего рода лимфатическим узлом в глазу. Если иммунитет нарушен, то антигены болезнетворных микроорганизмов проникают по сосудам в радужку и ресничное тело, вызывая их воспаление. Выраженность симптомов воспаления будет зависеть от природы вируса, длительности воздействия на организм и степени подавленности иммунной системы.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Диагностика иридоциклита базируется на данных анамнеза (истории болезни), симптомах, общем состоянии организма и данных, полученных в ходе клинико-лабораторных исследований [5].</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Офтальмолог должен не просто обнаружить симптомы и причину иридоциклита, но и правильно направить пациента к профильному специалисту для лечения основного заболевания. Поэтому иногда требуется консультация терапевта, отоларинголога, фтизиатра, невролога, стоматолога и других врачей.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Обследование глаз</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При иридоциклите обследование глаза включает в себя:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">проверку остроты зрения (визометрия) с коррекцией и без неё;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">периметрию и кампиметрию (оценку поля зрения и его изменений);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">проверку цветоощущения (цветового зрения);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">переднюю и заднюю биомикроскопию (оценку структуры передних отделов глаза с использованием щелевой лампы);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">тонометрию (определение внутриглазного давления с помощью специального тонометра).</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Рентгенография</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Дополнительно проводится рентгенография органов грудной клетки, придаточных пазух носа и др. Это необходимо для того, чтобы определить причину иридоциклита, т. е. исключить распространение вредных микробов от первоисточника: из лёгких при туберкулёзе, из околоносовых пазух при хронических гайморитах, из кариозных зубов при нездоровой полости рта и т. д.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лабораторная диагностика иридоциклита</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Клинико-лабораторные исследования помогают офтальмологу диагностировать воспаление и сориентироваться в тактике дообследования, чтобы определить причину болезни и тактику терапии. Для этого требуется:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">общий анализ крови (количество разных фракций белка, исследование С-реактивного белка);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">анализ крови на стерильность (отсутствие или наличие в ней бактерий);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">общий анализ мочи;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">анализ крови и мочи на глюкозу (сахар);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">анализ кала на яйца гельминтов (глистов).</span></li>\r\n</ul>\r\n<p> </p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечение иридоциклита должно быть своевременным и по возможности направленным на устранение причины его возникновения.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Консервативное лечение иридоциклита ориентировано на профилактику образования задних синехий, снижение риска развития осложнений и включает меры неотложной помощи и плановую терапию. В первые часы заболевания показано закапывание в глаз средств, расширяющих зрачок (мидриатиков), НПВС, кортикостероидов, прием антигистаминных препаратов.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Плановое лечение иридоциклита проводится в условиях стационара, его основу составляет местная и общая антисептическая, антибактериальная или противовирусная терапия, введение противовоспалительных нестероидных и гормональных препаратов (в виде глазных капель, парабульбарных, субконьюнктивальных, внутримышечных или внутривенных инъекций. Кортикостероиды широко используются в лечении иридоциклита токсико-аллергического и аутоиммунного генеза.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При иридоциклите проводится дезинтоксикационная терапия (при выраженном воспалении - плазмаферез, гемосорбция), инстилляции растворов мидриатиков, предотвращающих сращение радужки с хрусталиком. Назначают антигистаминные средства, поливитамины, иммуностимуляторы или иммуносупрессоры (в зависимости от основного заболевания), местно-протеолитические ферменты для рассасывания экссудата, преципитатов и спаек. Часто при иридоциклите применяются физиотерапевтические процедуры: электрофорез, магнитотерапия, лазерная терапия.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Иридоциклит туберкулезной, сифилитической, токсоплазмозной, ревматической этиологии требует проведения специфической терапии под контролем соответствующих специалистов.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Хирургические лечение иридоциклита проводится при необходимости разделения спаек или (рассечение передних и задних синехий радужки), в случае развития вторичной глаукомы. В случае тяжелого осложнения гнойного иридоциклита с лизисом оболочек и содержимого глаза показано хирургическое удаление последнего (энуклеация, эвисцерация глаза).</span></p>",
"prevention": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Профилактика иридоциклита заключается в своевременном лечении основного заболевания, санации очагов хронической инфекции в организме.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">С учетом симптомокомплекса и этиологии различают несколько форм.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Экссудативная, или серозная – самая легкая разновидность. Заболевание проходит с образованием экссудата (серозной жидкости) в пространстве стекловидного тела, что приводит к помутнению прозрачных сред. Дополнительно наблюдается легкое покраснение радужки и склер. Форма имеет острое или подострое течение, но хорошо поддается лечению и редко вызывает осложнения. Имеет наиболее благоприятные прогнозы для восстановления. Общая симптоматика:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">слезоточивость глаз;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">светобоязнь;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">помутнение зрачка;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ощущение рези в глазах;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">покраснение склер и радужки;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">скачки внутриглазного давления;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ощущение пелены перед глазами;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">сужение зрачка.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Фибринозно-пластическая форма имеет ярко выраженное острое проявление. В составе экссудата появляются белки свернувшейся крови. Воспаленная радужка продолжает отекать и начинает соприкасаться со стенкой хрусталика. Между ними образуются спайки (синехии), что приводит к деформации зрачка – вплоть до полного зарастания. Заболевание приводит к тяжелым необратимым последствиям, после которых полное восстановление зрения невозможно. К общим симптомам экссудативной формы присоединяются:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ощущение распирания глазного яблока;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">искажение формы зрачка;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">изменение формы и цвета радужной оболочки;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">блефароспазмы.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Гнойный иридоциклит развивается при поражении бактериальной инфекцией – в качестве осложнения после выраженного фурункулеза, тонзиллита, гайморита. Протекает в тяжелой острой форме, к общим симптомам серозного и фибринозного воспаления присоединяется появление гнойного экссудата.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Вирусная, или геморрагическая форма – развивается при поражении вирусной инфекцией, имеет острое или подострое течение. Гной в экссудате отсутствует, характерный симптом – выраженное покраснение склер и радужки.</span></p>",
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"code": "H21.0",
"name": "Гифема",
"icd_name": "Гифема",
"gender": 0,
"age_min": 1,
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"cause": [
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"periodicity": 1,
"slug": "h21.0_gifema",
"lead": "патологическое состояние глаза, при котором в его передней камере (она находится между роговицей, радужкой и хрусталиком) появляется кровь",
"description": "",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Возникновение гифемы может быть вызвано одной из этих причин:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Травма глаза. Это особенно частая причина возникновения внутриглазных кровотечений. При этом травмы глаза подразделяются на два вида – проникающие, с поражением глазных оболочек и непроникающие (тупые), без поражения оболочек глаза.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Причиной излития крови в переднюю камеру при проникающей травме является разрыв глазных оболочек, сопровождающийся разрывом сосудов. В случае непроникающей травмы, разрыв сосудов и кровотечение возникают из-за резкого скачка внутриглазного давления. Кроме разрыва сосудов при непроникающей травме, причиной излития крови может стать разрыв внутренних оболочек глаза (радужной оболочки, выполняющей функцию защитной мембраны в передней части сосудистой оболочки глаза; цилиарного тела в сосудистой оболочке глаза, состоящего из группы мышц, изменяющих форму хрусталика; хориоидеи – сосудистой оболочки, обеспечивающей питание сетчатки).</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Офтальмологические операции. Осложнением как полостных, так и лазерных операций на глазах нередко становится возникновение гифемы. Это происходит из-за повреждения в процессе хирургического вмешательства сосудов радужки и цилиарного тела, результатом чего и становится кровотечение. С такими кровотечениями врачи легко справляются во время хирургической операции. Однако, и в послеоперационном периоде, практически несколько месяцев риск возникновения гифемы сохраняется, так как кровотечение может возникнуть вновь из поврежденного на операции сосуда. Кроме того, в месте операционного разреза, нередко происходит рост новообразованных сосудов, с дефектами сосудистой стенки и предрасположенных к разрывам.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Некоторые заболевания глаз. Болезни глаз, сопровождающиеся ростом по радужной оболочке новообразованных сосудов, также могут являться причиной возникновения гифемы. К этим заболеваниям относят некомпенсированный тяжелый сахарный диабет, тромбоз центральной вены сетчатки и ее ветвей, внутриглазные опухолевые образования и пр. Растущие новообразованные сосуды крови имеют неполноценные хрупкие стенки, которые при малейшем колебании артериального или внутриглазного давления рвутся с излитием крови в переднюю камеру глаза.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Общие заболевания организма. Системные заболевания, связанные с нарушением свертываемости крови, такие как гемофилия, анемия или рак крови, нередко приводят к возникновению гифемы, казалось бы, без видимых офтальмологических причин. Кроме того, возникновению гифемы может способствовать злоупотребление алкоголем.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Кровь, излившаяся в переднюю камеру, может вызывать некоторые осложнения. Как правило, они возникают при выраженной гифеме, с полностью заполненной кровью передней камерой. Особенно серьезными осложнениями в подобной ситуации становятся: прокрашивание кровью роговицы и стойкое повышение внутриглазного давления – вторичная глаукома. Прокрашивание роговицы кровью приводит к ухудшению зрения даже после того, как сама гифема рассосется, так как оно долго не проходит и со временем способно даже увеличиваться.</span></p>",
"pathogenesis": "",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Диагностика гифемы основывается на данных анамнеза, объективного осмотра, результатов проведенной биомикроскопии глаза, гониоскопии, визометрии, тонометрии, ультразвукового В-сканирования. В анамнезе у большинства пациентов наблюдается травматическое повреждение глазного яблока, оперативные вмешательства, заболевания крови или патологии глаз, сопровождающиеся усилением процессов ангиогенеза. При объективном осмотре микрогифема не определяется. Для ее верификации необходимо провести микроскопию внутриглазной жидкости, в которой будут определяться следы форменных элементов крови. </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Методом биомикроскопии с использованием щелевой лампы определяется пул циркулирующих эритроцитов в жидкости передней камеры глаза или цельная кровь. Выявляются другие органические изменения в результате травмы (субконъюнктивальные кровоизлияния, факодонез, разрыв сфинктера радужки, инородные тела глаза и т. д.). Ультразвуковое В-сканирование позволяет визуализировать признаки травматического повреждения даже при тотальной гифеме и определить источник кровотечения.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Микрогифема не требует специального лечения. Консервативная терапия на I, II стадии заболевания предполагает местное применение капель кортикостероидов (преднизолон) и мидриатиков (атропин). Угнетая процессы фибринолиза, кортикостероиды профилактируют развитие рецидивов. Антифибринолитической активностью обладает аминокапроновая кислота, которая используется системно. Атропин предотвращает образование передних синехий, снижает проявления фотофобии, уменьшает выраженность спазма аккомодации. При повышении ВГД рекомендован пероральный прием ингибиторов карбоангидразы (ацетазоламид, дорзоламид).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Хирургическое лечение гифемы проводится на III, IV стадии заболевания. Для промывания передней камеры глаза выполняются два параллельных друг другу парацентеза. В одно из отверстий вливают сбалансированный кристаллоидный раствор, через второе удаляется кровь и образовавшиеся кровяные сгустки. Проведение трабекулэктомии улучшает отток крови, приводит к снижению ВГД и ликвидирует зрачковый блок. Облитерация послеоперационной фистулы происходит самостоятельно.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечение пациентов с серповидно-клеточной анемией в анамнезе исключает использование ингибиторов карбоангидразы. Препараты данной группы снижают парциальное давление кислорода в жидкости передней камеры, что ведет к деформации эритроцитов. Деформированные форменные элементы приводят к блокаде путей оттока внутриглазной жидкости, что провоцирует повышение ВГД.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечение гифемы в большинстве случаев проводится амбулаторно. Стационарному лечению подлежит группа больных с высокими значениями ВГД, не поддающимися медикаментозной коррекции, пациенты с патологиями крови и в возрасте до 3 лет. Рекомендован постельный режим с максимально возможным ограничением двигательной активности. В постели следует лежать с приподнятым на 40-50 градусов изголовьем. На протяжении дня необходимо носить защитный щиток на пораженном глазу.</span></p>",
"prevention": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В целях предупреждения данной патологии следует соблюдать технику безопасности при выполнении потенциально опасных действий, которые могут стать причиной травм глаз. Также при появлении любых патологий зрения необходимо проводить своевременное и адекватное лечение или коррекцию.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Клиническая картина гифемы зависит от объема крови в передней камере глаза. При микрогифеме заболевание носит латентное течение. Иногда пациенты отмечают незначительный дискомфорт, гиперемия не характерна. Для первой стадии свойственно появление «тумана» перед глазами. Больные могут наблюдать узкую полоску красно-коричневого цвета при самостоятельном осмотре. При травматическом происхождении возможно развитие фотофобии и болевого синдрома. На второй и третьей стадии нарастают клинические проявления: уровень крови заметен на расстоянии, появляется пелена перед глазами, зрение снижается незначительно. Присоединяется неврологическая симптоматика: «мушки» перед глазами, головная боль, головокружение. Тотальная, или «черная», гифема сопровождается полной потерей зрения. У ряда пациентов сохраняется только световосприятие. Даже после проведенного лечения в роговице определяется следовое количество форменных элементов, что изменяет ее окраску и отрицательно влияет на зрительные функции.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Скопление крови в передней камере глаза провоцирует повышение внутриглазного давления, что является предиктором развития вторичной глаукомы. К отдаленным осложнениям гифемы относится образование передних синехий по периферии глазного яблока. Сочетание повышения ВГД, окклюзии сосудов и контузии при травматическом кровоизлиянии приводит к атрофии зрительного нерва. Данная патология вызывает расщепление цилиарной мышцы и смещение радужки и хрусталика кзади, как следствие сужается шлеммов канал вплоть до его полной блокады. Эти обстоятельства, а также механическое давление скопившегося объема крови приводит к углублению угла, ограниченного спереди роговицей и склерой, сзади – цилиарным телом и радужкой, что лежит в основе рецессии угла передней камеры глаза.</span></p>",
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