Диагностика синдрома лимбальной недостаточности

Авторы

  • Б.Э. Малюгин НМИЦ «МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова» Минздрава России, Москва; Московский государственный медико-стоматологический университет имени А.И. Евдокимова, Москва
  • С.А. Борзенок НМИЦ «МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова» Минздрава России, Москва; Московский государственный медико-стоматологический университет имени А.И. Евдокимова, Москва
  • С.Ю. Калинникова НМИЦ «МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова» Минздрава России, Москва
  • М.Ю. Герасимов НМИЦ «МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова» Минздрава России, Москва

Ключевые слова:

синдром лимбальной недостаточности, импрессионная цитология, лазерная сканирующая конфокальная микроскопия, бокаловидные клетки, цитокератины, сквозная кератопластика, цитокины

Аннотация

Актуальность. Синдром лимбальной недостаточности (СЛН) является патологией, приводящей к снижению зрения, развитию неоваскуляризации роговицы, появлению персистирующих эрозий и негативному воздействию на качество жизни пациента. Известно, что эффективность трансплантации роговицы при этом невысока и требует неоднократных повторных вмешательств. Одной из важных проблем, является отсутствие четкого алгоритма диагностики и стандартизированного набора методов исследований для данного заболевания. Цель. Подробное изложение основных методов диагностики СЛН.
Материал и методы. Произведен системный анализ научных публикаций отечественных и зарубежных авторов на ресурсах PubMed, Medline, eLibrary, а также диссертационных работ и учебников c 1992 до 2021 г., посвященных существующим на настоящий момент методам диагностики СЛН.
Результаты. Основными прижизненными методами диагностики СЛН помимо биомикроскопии являются: окрашивание глазной поверхности, импрессионная цитология с выявлением специфических цитокератинов, конфокальная микроскопия, оптическая когерентная томография (ОКТ) переднего отрезка и ОКТ-ангиография.
Заключение. У пациентов с конъюнктивализацией и васкуляризацией роговицы следует проявлять настороженность и проводить дополнительную диагностику на предмет наличия СЛН. Диагностика данного заболевания должна быть комплексной и, помимо сбора анамнеза и биомикроскопии с обязательной прижизненной окраской (флюоресцеин), включать инструментальные исследования, основанные на детальной визуализации переднего отрезка глаза с высоким разрешением (ОКТ, конфокальная микроскопия), а также лабораторной диагностике (цитология, иммуноцитохимия).

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