Ãëàâà 3. ÑÒÐÎÅÍÈÅ ÃËÀÇÍÎÃÎ ßÁËÎÊÀ. 1. Êðîâîòîê â êàïèëëÿðàõ õîðèîèäåè îäèí èç ñàìûõ èíòåíñèâíûõ — 800—1200/100 ãð/ìèí
1. Êðîâîòîê â êàïèëëÿðàõ õîðèîèäåè îäèí èç ñàìûõ èíòåíñèâíûõ — 800—1200/100 ãð/ìèí.
2. Ê õîðèîèäåå íàïðàâëÿåòñÿ 85% âñåãî îáúåìà êðîâè, íàïðàâëåííîãî ê ãëàçíîìó ÿáëî êó (ê ñåò÷àòêå òîëüêî 4%).
3. Êðîâü â ïîñòêàïèëëÿðíûõ êðîâåíîñíûõ ñîñóäàõ õîðèîèäåè ñòîëü æå áîãàòà êèñëîðî äîì, êàê è àðòåðèàëüíàÿ êðîâü [117, 293, 828].
4. Êðîâîîáðàùåíèå â ñîñóäàõ õîðèîèäåè íå àóòîðåãóëèðóåòñÿ, ïîñêîëüêó íàñûùåíèå êðî âè óãëåêèñëûì ãàçîì ìèíèìàëüíîå [114, 117, 1196].
5. Ìàêñèìàëüíàÿ ñòèìóëÿöèÿ ñèìïàòè÷åñ êîé íåðâíîé ñèñòåìû ïðèâîäèò ê óìåíüøåíèþ îáúåìà êðîâîîáðàùåíèÿ òîëüêî íà 60% [114, 117, 1196]; ñòåíêà êàïèëëÿðíûõ ñîñóäîâ íå ãåð ìåòè÷íà è ïðîíèöàåìà äëÿ ðàçëè÷íûõ âåùåñòâ, âêëþ÷àÿ áåëêè.
Òàêèì îáðàçîì, èìåþùèåñÿ àíàòîìè÷åñêèå è ôèçèîëîãè÷åñêèå ñâåäåíèÿ íå ïîçâîëÿëè èññëåäîâàòåëÿì îáúÿñíèòü ìåõàíèçìû ðàçâèòèÿ èøåìèè õîðèîèäåè. Òåì íå ìåíåå, ó÷àñòêè èøåìèè, à òàêæå èíôàðêòà õîðèîèäåè, íå ñòîëü óæ è ðåäêîå ÿâëåíèå [77, 333, 515].
Áûëè ïðîâåäåíû ìíîãî÷èñëåííûå ýêñïåðèìåíòàëüíûå èññëåäîâàíèÿ, ñâîäèâøèåñÿ ê ââåäåíèþ â êðîâÿíîå ðóñëî ìèêðî÷àñòèö øàðîâèäíîé ôîðìû [80, 210, 464, 893, 1198, 1199] èëè ôëþîðåñöåèíà [77, 257, 460, 515, 1108]. Íî è ïðè ýòîì, îáúÿñíåíèÿ ýòîìó ÿâëåíèþ íàéäåíî íå áûëî. Ëèøü èñïîëüçîâàíèå ôëþîðåñöåèíà ïîçâîëèëî íàáëþäàòü íàïîëíåíèå ó÷àñòêîâ õî-ðèîêàïèëëÿðíûõ ñîñóäîâ ôëþîðîñöåèíîì â âèäå ñåêòîðîâ. Ïîñëåäîâàòåëüíîñòü è ïëîùàäü íàïîëíåíèÿ ñîñóäîâ êðîâüþ ÷åòêî ñîîòâåòñòâîâàëà ñòðîåíèþ «õîðèîêàïèëëÿðíîé äîëüêè». Äîëüêà íà÷èíàëà íàïîëíÿòüñÿ êðîâüþ ñ öåíòðàëüíûõ ó÷àñòêîâ è ëèøü ñïóñòÿ íåñêîëüêî ñåêóíä êðîâü ïîñòóïàëà ê ïåðèôåðèè. Ïîñêîëüêó ñòðîåíèå «äîëüêè» â ðàçëè÷íûõ ó÷àñòêàõ óâå-àëüíîãî òðàêòà ðàçëè÷íî (ñì. âûøå), ðàçëè÷íà è ñêîðîñòü êðîâåíàïîëíåíèÿ õîðèîèäåè â ðàçëè÷íûõ ó÷àñòêàõ.
Êîëè÷åñòâåííûå è êà÷åñòâåííûå õàðàêòåðèñòèêè êðîâîîáðàùåíèÿ â «äîëüêàõ» çàâèñÿò îò ìíîãèõ ïðè÷èí è, â ïåðâóþ î÷åðåäü, îò âíóòðèãëàçíîãî äàâëåíèÿ [257]. Óñòàíîâëåíî òàêæå, ÷òî âåíîçíàÿ êðîâü îòâîäèòñÿ îò êàæäîé «äîëüêè» â îòäåëüíîñòè. Ïðè ýòîì êðîâü ñîñåäíèõ «äîëåê» íå ñìåøèâàåòñÿ. Ïî âñåé âèäèìîñòè, òàêàÿ ñèñòåìà êðîâîîáðàùåíèÿ ïðåäîïðåäåëÿåò ñóùåñòâîâàíèå íàèáîëåå áûñòðîãî è êîðîòêîãî ïóòè îòòîêà âåíîçíîé êðîâè èç õîðèîèäåè. Ñ äðóãîé ñòîðîíû, âîçíèêàåò âåðîÿòíîñòü â îïðåäåëåííûõ óñëîâèÿõ âîçíèêíîâåíèÿ èøåìèè õîðèîèäåè íà ãðàíèöå «äîëåê». Íàèáîëåå ÷àñòî èøåìèÿ íàñòóïàåò ïðè îêêëþçèè êîðîòêèõ çàäíèõ ðåñíè÷íûõ àðòåðèé, à òàêæå ñîñóäîâ ãëàçíèöû [460, 470].
Ðàçâèòèå èøåìèè õîðèîèäåè íåáëàãîïðèÿòíî âëèÿåò íà ñòðîåíèå è ôóíêöèè ñåò÷àòîé îáîëî÷êè. Èñ÷åçàþò ôîòîðåöåïòîðû íàðóæíîãî ÿäåð-
íîãî ñëîÿ, íàñòóïàåò ìèãðàöèÿ êëåòîê ïèãìåíòíîãî ýïèòåëèÿ â ñåò÷àòêó.
Òàêèì îáðàçîì, íà îñíîâàíèè ïðèâåäåííûõ äàííûõ âèäíà íåñîñòîÿòåëüíîñòü êîíöåïöèè î íåâîçìîæíîñòè ðàçâèòèÿ èøåìèè õîðèîèäåè èç-çà áîëüøîãî êîëè÷åñòâà àíàñòîìîçîâ ìåæäó ñîñóäàìè.
Âîçðàñòíûå èçìåíåíèÿ ñîñóäèñòîé îáîëî÷êè.  ñîñóäèñòîé îáîëî÷êå ãëàçà ñ âîçðàñòîì óìåíüøàåòñÿ êîëè÷åñòâî ýëàñòè÷åñêîé òêàíè [1049], à òàêæå óìåíüøàåòñÿ òîëùèíà è ñàìîé ñîñóäèñòîé îáîëî÷êè [868]. Âîêðóã êðóïíûõ ñîñóäîâ ôîðìèðóåòñÿ øèðîêàÿ ïðîñëîéêà âîëîêíèñòîé òêàíè. Ïðè ýòîì ñîñóäû õîðèîèäåè íà÷èíàþò íàïîìèíàòü ñîñóäû ðàäóæêè.  äîïîëíåíèå ê îïèñàííîìó ñêëåðîçó ñîñóäèñòîé ñòåíêè èçìåíÿåòñÿ òàêæå ÷èñëî è êàëèáð ñîñóäîâ. Ïðèâåäåííûå ñòðóêòóðíûå èçìåíåíèÿ ñîïðîâîæäàþòñÿ óìåíüøåíèåì ñêîðîñòè íàïîëíåíèÿ õîðèîêàïèëëÿðíîãî ñëîÿ, ÷òî ïîêàçàíî ïðè ïîìîùè ôëþîðåñöåíòíîé àíãèîãðàôèè. Ïîÿâëÿþòñÿ ïÿòíà ãèïîôëþîðåñöåíöèè, õîòÿ îáùàÿ èíòåíñèâíîñòü ñâå÷åíèÿ ñîõðàíÿåòñÿ íåçàâèñèìî îò âîçðàñòà [525].
Ðåãåíåðàöèÿ óâåàëüíîãî òðàêòà. Ïîñëå ïîâðåæäåíèÿ ëþáîãî ó÷àñòêà óâåàëüíîãî òðàêòà íàñòóïàåò ëèøü çàìåñòèòåëüíàÿ ðåãåíåðàöèÿ.  ýòó îáëàñòü ïåðâîíà÷àëüíî ìèãðèðóþò êëåòêè ñîåäèíèòåëüíîé òêàíè (ôèáðîáëàñòû), êîòîðûå ñèíòåçèðóþò ìåæêëåòî÷íîå âåùåñòâî è êîëëàãåí, âûïîëíÿþùèå äåôåêò. Çàòåì íàñòóïàåò îðãàíèçàöèÿ âîëîêíèñòîé òêàíè ñ îáðàçîâàíèåì ñîåäèíèòåëüíîòêàííîãî ðóáöà. Ðóáåö, êàê ïðàâèëî, äîâîëüíî èíòåíñèâíî ïèãìåíòèðîâàí, ïîñêîëüêó â íåì ñêàïëèâàþòñÿ çåðíà ìåëàíèíà, âûñâîáîäèâøèåñÿ èç ïîâðåæäåííûõ ñòðîìàëü-íûõ ìåëàíîöèòîâ. Ñóùåñòâóþò îïðåäåëåííûå ðàçëè÷èÿ â ñêîðîñòè çàìåñòèòåëüíîé ðåãåíåðàöèè ðàäóæíîé îáîëî÷êè. Ýòî ñâÿçàíî ñ òåì, ÷òî ïîñëå åå ïîâðåæäåíèÿ (ðàäèàëüíûå ðàçðûâû) êðàÿ ðàíû ðàñõîäÿòñÿ.  òàêèõ ñëó÷àÿõ ðóáöåâàíèÿ âîîáùå íå ïðîèñõîäèò.
Ëèòåðàòóðà
1. Àáðàìîâ Â. Ã. Áîëåçíü òðàíñïëàíòàòà ðîãî âèöû.— ßðîñëàâëü: Âåðõ.-Âîëæ. êí. èçä-âî, 1972. — 215 ñ.
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Ëèòåðàòóðà
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