Wang Ningli, Wu Heping, Fan Zhigang
Department of Glaucoma, Zhongshan Ophthalmic Center, Zhongshan University, Guangzhou 510060, China.
Chin Med J (Engl). 2002 Nov;115(11):1706-15.
To review the major progress in primary angle closure glaucoma (PACG).
Contents of this article were selected from the original papers or reviews related to primary angle closure glaucoma published in Chinese and foreign journals. A total of 76 articles were selected from several hundred original articles or reviews. The content of selected articles is in accordance with our purpose and the authors are authorized scientists in the study of glaucoma.
Primary angle closure glaucoma is the most common type of glaucoma in the Sino-Mongoloid population. PACG in Chinese can be classified into three types depending on the mechanism of angle closure: 1. Multimechanism: 54.8% of Chinese PACG is caused by co-existing factors. The pattern of angle closure appears to mainly be creeping closure. After iridectomy, almost 40% of the cases still manifest a positive response to the darkroom provocative test and progressive synechial closure or recurrent angle closure may occur. Several mechanisms are involved in this form of PACG such as pupillary blocking component, iris crowding component and anterior positioned ciliary body. These factors can coexist in the follow patterns: pupillary blocking and iris crowding coexist; pupillary blocking and anterior positioned ciliary body coexist or three of them co-exist. 2. Pupillary block: (38.1% of Chinese PACG) is caused by iris bombe due to pupillary block with acute or subacute attack. It responds well to iridectomy or laser iridotomy. 3. Non-pupillary blocking: (7.8% of Chinese PACG). They usually have a deeper anterior chamber, and tend to be younger (below 40 years of age). Angle closure in this form of PACG is caused by: iris crowding mechanism or/and anteriorly positioned ciliary body against iris root to angle. It is critical to distinguish multi-mechanism PACG from other types. The initial treatment for this type of PACG is also iridectomy, but after the pupillary block component is eliminated by iridectomy, the residual non-pupillary blocking components should be highlighted by a diagnostic treatment procedure or by a ultrasound biomicroscopy (UBM) provocative test. Finally, the role of UBM in the observation and evaluation of the mechanism of angle closure is discussed and future research directions on PACG in Asians are proposed.
Chinese eyes have been recognized to be prone to the development of creeping angle closure. There is some direct evidence that creeping angle closure is caused by multiple mechanisms. Further study on this topic is needed.
回顾原发性闭角型青光眼（PACG）的主要进展。
本文内容选自国内外期刊发表的与原发性闭角型青光眼相关的原始论文或综述。从数百篇原始文章或综述中总共选取了76篇文章。所选文章的内容符合我们的目的，且作者均为青光眼研究领域的权威科学家。
原发性闭角型青光眼是中蒙古人种中最常见的青光眼类型。中国的PACG根据房角关闭机制可分为三种类型：1. 多机制型：54.8%的中国PACG由多种共存因素引起。房角关闭模式主要表现为渐进性关闭。虹膜切除术后，近40%的病例对暗室激发试验仍呈阳性反应，可能发生渐进性虹膜粘连关闭或复发性房角关闭。这种形式的PACG涉及多种机制，如瞳孔阻滞成分、虹膜拥挤成分和睫状体前位。这些因素可按以下模式共存：瞳孔阻滞与虹膜拥挤共存；瞳孔阻滞与睫状体前位共存或三者同时存在。2. 瞳孔阻滞型：（占中国PACG的38.1%）由瞳孔阻滞导致虹膜膨隆引起，发作急性或亚急性。对虹膜切除术或激光虹膜切开术反应良好。3. 非瞳孔阻滞型：（占中国PACG的7.8%）。它们通常前房较深，且发病年龄较轻（40岁以下）。这种形式的PACG房角关闭由以下原因引起：虹膜拥挤机制或/和睫状体前位顶压虹膜根部至房角。将多机制型PACG与其他类型区分开来至关重要。这类PACG的初始治疗也是虹膜切除术，但在通过虹膜切除术消除瞳孔阻滞成分后，应通过诊断性治疗程序或超声生物显微镜（UBM）激发试验突出残留的非瞳孔阻滞成分。最后，讨论了UBM在房角关闭机制观察和评估中的作用，并提出了亚洲人PACG未来的研究方向。
中国人的眼睛被认为易于发生渐进性房角关闭。有一些直接证据表明渐进性房角关闭是由多种机制引起的。对此主题需要进一步研究。
