Современные аспекты этиологии и патогенеза хронического периферического увеита

Периферический увеит является одним из наиболее тяжелых эндогенных увеитов, который развивается чаще у лиц молодого возраста и характеризуется скудными клиническими проявлениями на ранних стадиях развития. Значительное и зачастую необратимое снижение остроты зрения связано с развитием отдаленных осложнений хронического периферического увеита (ХПУ) – осложненной катарактой (частота развития до 57%), кистозным макулярным отеком (частота развития до 31%), офтальмогипертензией и глаукомой (частота развития до 16%). Показатель заболеваемости ХПУ составляет 1,5 на 100 000 в год. Несмотря на высокую иммунную привилегированность, глаз подвержен инфекционным и воспалительным заболеваниям. Клинические и гистопатологические данные указывают на аутоиммунное происхождение ХПУ, связанное с возможной реакцией на эндогенный антиген неизвестного происхождения. Основными эффекторами воспаления периферических хориоретинальных структур являются CD4⁺Т-лимфоциты, обнаруживающиеся при ХПУ в паравазальных инфильтратах и витреоретинальных экссудатах. Важная роль в патогенезе заболевания отводится интерлейкинам IL-6 и IL-8, фактору некроза опухоли á – TNFá, сосудистому эндотелиальному фактору роста – VEGF и микрорибонуклеиновой кислоты, повышенная экспрессия которых обнаруживается у большинства больных ХПУ. Одним из потенциальных триггеров внутриглазного воспаления является нарушения состояния бактериального микробиома кишечника. Выявлена также генетическая предрасположенность к ХПУ, обусловленная лейкоцитарным антигеном человека и некоторыми другими генами. Для разработки эффективного фармакологического лечения ХПУ необходимо расширять и углублять знания о патогенезе данного заболевания. Статья представляет собой литературный обзор современных научных представлений об этиологии и механизмах развития ХПУ.

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