ПАТОГЕНЕТИЧЕСКИЕ МЕХАНИЗМЫ НАРУШЕНИЯ ЭПИТЕЛИЗАЦИИИ ФОРМИРОВАНИЯ ПЕРСИСТИРУЮЩИХ ЯЗВ ТРАНСПЛАНТАТАУ ПАЦИЕНТОВ С ДЕСТРУКТИВНЫМИ ПРОЦЕССАМИ РОГОВИЦЫПОСЛЕ СКВОЗНОЙ КЕРАТОПЛАСТИКИ

[摘要] Keratoplasty in patients with recurrent destructive processes in the cornea nowadays remains one of the most serious problems in ophthalmic surgery. Purpose.The analysis of results of penetrating keratoplasty (PK) in patients with destructive processes of the cornea or the corneal graft depending on the initial level of GDNF and the activity of the MAP kinase cascade of the signaling pathways. Material  and  methods.   The  analysis  of  the  results  of  PK  was performed in 23 patients (34 eyes) with acute destructive processes of cornea or the corneal graft in different etiologies. The follow-up period was from 6 months to 2 years. The analysis of the results of treatment was carried out depending on the condition of the corneal graft at various times after PK.The  immunohistochemical  examination  of  the  biological  material (corneal disks of the recipient) was performed using antibodies to GDNF, phospho-ERK1 / 2, phospho-JNK1 / 2, Ki67, GAP43, Bcl2 and Bax. Results.   The  time  of  epithelialization  of  the  graft  after  PK  in destructive processes of the cornea was increased in 79% of cases. When the epithelialization of the corneal graft was completed more than 6 and 10 days after PK in the postoperative period persistent erosions of the graft (PEG) with ulceration were formed in 22% and 89% of cases, respectively.The intensity of immunohistochemical reactions with antibodies to GDNF, phospho-ERK1 / 2, phospho-JNK1 / 2 in corneal disks at the epithelialization time of up to 5, 10 days and more eythan 10 days after PK was reduced from moderately positive to weakly positive and negative, respectively.When the time of epithelialization was completed in 6-10 days and there was not PECG, the intensity of reactions with antibodies to GDNF remains moderately positive, phospho-ERK1 / 2, phospho-JNK1 / 2 was lightly positive; when there was PEG the intensity of all reactions was weakly positive. Conclusion.The severity of the destructive pathological process in the cornea and postoperative complications after PK in patients with destructive corneal processes depend on the degree of GDNF deficiency, the decrease in the activity of the MAP kinase cascade of signaling pathways; the density of nerve plexuses in the own corneal tissue or corneal graft, and the activity of apoptosis processes.

[学科分类] 眼科学

[关键词] penetrating keratoplasty (PK);destructive processes in the cornea;the epithelialization of the graft;persistent erosion of the graft (PEG);сквозная кератопластика (СК);деструктивные процессы роговицы;эпителизация трансплантата;персистирующая эрозия трансплантата (ПЭТР)