THE ROLE OF INFLAMMATORY PROCESSES IN THE DEVELOPMENT OF OPTIC NEURITIS: CLINICAL AND DIAGNOSTIC ASPECTS

Аннотация

Currently, the number of working-age people suffering from hypertension, atherosclerosis, ischemic heart disease and diabetes mellitus has significantly increased. These diseases are often accompanied by circulatory disorders in the vessels of the retina and the vessels feeding the optic nerve, age-related degenerative changes, etc. A significant percentage of such patients become disabled. The most common underlying pathology in these diseases is ischemia. Keywords: All ischemic processes in the eye, acute and chronic conditions. Introduction: The risk of developing ischemic conditions of the eye is determined by the anatomical features of the microcirculatory bed and, to a certain extent, depends on the degree of development of collateral blood circulation present in the prelaminar, laminar and postlaminar sections of the optic nerve [11, 15]. Currently, there is no classification of ocular ischemia. The close relationship between damage to various parts of the circulatory system, as well as the mechanisms of development of ischemia, does not allow a clear division of ischemic processes in the eye according to etiological and pathogenetic signs. Since ischemic diseases of the eye are polyetiological, have a diverse pathogenesis and a multifaceted clinical picture, it is difficult to imagine an ideal classification. The only clear way to classify all ischemic processes in the eye into acute and chronic. Dystrophic changes in the retina are among the most severe eye lesions. They occur in both young and old people and are often characterized by a progressive course, leading to a decrease in visual function and often disability. The issue of classification of degenerations has not been finally resolved. Without discussing the existing classifications, it is recommended to take as a working option the proposal of Duke-Elder (1967), who divides all dystrophic changes in the retina into degenerations associated primarily with circulatory disorders in the choriocapillary layer and retinal blood vessels, and here are identified degenerations and degenerations. In the first group of diseases, chronic ischemia is the main pathogenetic link. 455 NEW RENAISSANCE 2025 MARCH INTERNATIONAL SCIENTIFIC AND PRACTICAL CONFERENCE VOLUME 2 | ISSUE 3 In the second group of retinal degenerations, the ischemic component is secondary. But it is very important to take into account its presence when choosing a treatment complex. Among the severe degenerative, dystrophic changes in the retina are lesions of its macular region. Such lesions are observed in 25-40% of patients, more often in the elderly. This is explained by the fact that the macular region is usually in a worse nutritional state than the peripheral parts of the retina. In the pathogenesis of age-related macular degeneration, sclerotic changes in the choroidal vessels and hemodynamic shifts in the ophthalmic artery are of great importance, which can be observed both in arterial hypertension and in hypotension. Hoyng (1998) found that 1% of patients with central age-related macular degeneration become almost blind by the age of 65-74, with visual acuity of 0.01-0.02. In the age group over 85 years, the number of blind people among such patients reaches 11%. An important problem is the treatment of glaucomatous optic atrophy. Most ophthalmologists believe that optic nerve atrophy is mainly associated with circulatory problems. This problem is especially acute in the treatment of advanced glaucoma, when vascular diseases often accompany this eye disease (atherosclerosis, hypertension or diabetes mellitus) leading to an acute shortage of blood supply and complete exhaustion of compensatory abilities. After surgical treatment, such patients often achieve normalization of IOP. However, long- term results of the study show that despite normalization of IOP, visual function continues to decline [1, 12]. Acute ischemia of the posterior segment of the eye manifests itself in the form of circulatory disorders in the central cerebral artery and its branches, anterior and posterior ischemic neuropathy. It can be a consequence of existing chronic ocular ischemia (diabetic or hypertensive angioretinopathy, degenerative changes in the retina, stenosis of the carotid, ophthalmic arteries, temporal arteritis). The basis of arterial blood flow disorders can also be general angiospastic diseases and eyeball injuries. Cases of ischemic neuropathy and circulatory disorders in the central coronary artery and its branches have been described against the background of hypotension, when taking certain medications, and after cardiac surgery (risk factors in this case are hypothermia, anemia, increased intraocular pressure, and microembolization) [31, 35]. Spontaneous recovery from ischemic neuropathy occurs in a small proportion of cases [29, 30]. Acute circulatory disorders in the retina and optic nerve almost always lead to partial loss of vision, and in some cases to complete blindness. The p