medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-469medsovet-8040Research ArticleПРАКТИКАPRACTICEСовременные методы исследования роговицы и влаги передней камеры глаза при передних увеитах, ассоциированных со спондилоартритамиA modern approach to diagnostic methods of the cornea and aqueous humor of anterior chamber of the eye in patients with anterior uveitis, associated with spondyloarthritishttps://orcid.org/0000-0003-2982-7418РазумоваИ. Ю.RazumovaI. Yu.

Разумова Ирина Юрьевна - к.м.н., научный сотрудник отдела патологии сетчатки и зрительного нерва.

119021, Москва, ул. Россолимо, д. 11а, б

Irina Yu. Razumova - Cand. Sci. (Med.), Researcher of the Department of Pathology of the Retina and Optic Nerve.

11a, b, Rossolimo St., 119021, Moscow

torazumova@gmail.comhttps://orcid.org/0000-0001-5692-1800СурнинаЗ. В.SurninaZ. V.

Сурнина Зоя Васильевна - к.м.н., старший научный сотрудник отдела патологии оптических сред глаза.

119021, Москва, ул. Россолимо, д. 11а, б

Zoya V. Surnina - Cand. Sci. (Med.), Senior Researcher of the Department of Pathology of Optical Media of the Eye.

11a, b, Rossolimo St., 119021, Moscow

medzoe@yandex.ruhttps://orcid.org/0000-0002-5493-6045ГодзенкоА. А.GodzenkoA. A.

Годзенко Алла Александровна - д.м.н., доцент, профессор кафедры ревматологии.

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

Alla A. Godzenko - Dr. Sci. (Med.), Associate Professor, Professor of the Department of Rheumatology.

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993

alla1106@mail.ruhttps://orcid.org/0000-0002-9239-9156АгаеваЛ. М.AgaevaL. M.

Агаева Лала Мамедалиевна – аспирант.

119021, Москва, ул. Россолимо, д. 11а, б

Lala М. Agaeva - Resident.

11a, b, Rossolimo St., 119021, Moscow

lalovski.med@gmail.comhttps://orcid.org/0000-0003-4043-456XЮсефЮ. Н.YusefYu. N.

Юсеф Юсеф Наим - д.м.н., профессор, доцент кафедры офтальмологии, Первый МГМУ имени И.М. Сеченова (Сеченовский Университет); директор, НИИГБ имени М.М. Краснова.

119991, Москва, Большая Пироговская ул., д. 2, стр. 4; 119021, Москва, ул. Россолимо, д. 11а, б

Yusef N. Yusef - Dr. Sci. (Med.), Professor, Associate Professor of the Department of Ophthalmology, Sechenov First MSMU (Sechenov University); Director, Krasnov RIED.

6, Bldg. 1, Bolshaya Pirogov skaya St., Moscow, 119991; 11a, b, Rossolimo St., 119021, Moscow

info@eyeacademy.ruНаучно-исследовательский институт глазных болезней имени М.М. КрасноваРоссияKrasnov Research Institute of Eye DiseaseRussian FederationРоссийская медицинская академия непрерывного профессионального образованияРоссияRussian Medical Academy of Continuous Professional EducationRussian FederationНаучно-исследовательский институт глазных болезней имени М.М. Краснова; Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияKrasnov Research Institute of Eye Disease; Sechenov First Moscow State Medical University (Sechenov University)Russian Federation202321012024023375381Copyright © Разумова И.Ю., Сурнина З.В., Годзенко А.А., Агаева Л.М., Юсеф Ю.Н., 20242024Разумова И.Ю., Сурнина З.В., Годзенко А.А., Агаева Л.М., Юсеф Ю.Н.Razumova I.Y., Surnina Z.V., Godzenko A.A., Agaeva L.M., Yusef Y.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8040

Передний увеит – доминирующее клиническое внесуставное проявление спондилоартритов, ассоциированных с носительством аллели человеческого лейкоцитарного антигена (HLA-B27), которое может предшествовать поражению суставов и позвоночника. В 20–30% случаев увеит протекает с частыми рецидивами – до 5–6 обострений в год, зачастую имеет затяжной характер и плохо поддается местной противовоспалительной терапии, что приводит к снижению зрения и ухудшению качества жизни. Своевременная и точная оценка степени тяжести внутриглазного воспаления играет важную роль в постановке диагноза и в выборе правильной тактики лечения переднего увеита у пациентов со спондилоартритом, ассоциированным с HLA-B27. В настоящее время стандартным клиническим подходом к оценке воспалительного процесса является наличие воспалительных клеток и их количество во влаге передней камеры по классификации SUN с использованием изображений, полученных с помощьющелевой лампы. Однако оценка SUN является субъективной. Более того, индивидуальная вариабельность количества клеток во влаге передней камеры, являющаяся основным диагностическим критерием увеита, может усугубляться определенными условиями тестирования, например яркостью световой полосы щелевой лампы, калибровкой размера луча, интенсивностью источника света. Достижения в технологии оптической визуализации и совершенствование уже известных методов предлагают новые возможности для объективной, точной и количественной оценки воспаления. В статье изложены возможности исследования роговицы и влаги передней камеры глаза при помощи таких методов исследования переднего отрезка глаза, как оптическая когерентная томография переднего сегмента, конфокальная микроскопия роговицы и кератотопометрия.

Anterior uveitis is the dominant clinical extra-articular manifestation of spondyloarthritis associated with the carriage of the human leukocyte antigen allele (HLA-B27), which may precede joint and spinal involvement. In 20–30% of cases, uveitis occurs with frequent relapses – up to 5–6 exacerbations per year, often has a protracted character and is poorly amenable to local anti-inflammatory therapy, which leads to a decrease in vision and a deterioration in the quality of life. Timely and accurate assessment of the severity of intraocular inflammation plays an important role in making a diagnosis and in choosing the right treatment tactics for treating anterior uveitis in patients with HLA-B27-associated spondyloarthritis. The current standard clinical approach to assessing inflammation is the presence and number of inflammatory cells in the anterior chamber aqua humor according to the SUN classification using slit lamp imaging. However, the assessment of SUN is very subjective. Moreover, the individual variability in anterior chamber cell count, which is the main diagnostic criterion for uveitis, can be exacerbated by certain testing conditions, such as the brightness of the slit lamp light bar, light beam size calibration, light source intensity. Advances in optical imaging technology, the application of the latest technologies and the improvement of already known methods offer new opportunities for an objective, accurate and quantitative assessment of inflammation. The article describes the possibilities of studying the cornea and the anterior chamber of the eye using anterior segment optical coherence tomography, confocal microscopy of the cornea and keratotopometry.

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The authors declare that there are no conflicts of interest present.