Johnson G J, Foster P J
Department of Epidemiology and International Eye Health, Institute of Ophthalmology, UCL, Summertown, Oxford OX2 7QB, UK.
Eye (Lond). 2005 Oct;19(10):1119-24. doi: 10.1038/sj.eye.6701970.
Glaucoma is the second cause, after cataract, of world blindness. Approximately half is thought to be primary angle-closure glaucoma (ACG). This review asks whether ACG can be prevented on a population basis. METHODS AND POPULATIONS: Review of published information from the Inuit of Greenland, Canada and Alaska, and descriptions of recent studies in Asian populations in Mongolia, China and South-East Asia.
The Greenland Inuit have the shallowest anterior chamber depths (ACDs) so far recorded. The proportion of blindness due to ACG was reduced from 64% to 9% over 37 years by systematic optical measurement of central ACD and the van Herick test in the older Inuit, followed by gonioscopy and prophylactic iridectomy or laser iridotomy when indicated. In Mongolia, ultrasound measurement of central ACD had good sensitivity and specificity as a screening test. A randomized controlled trial of screening and prophylactic laser is being completed. In China and South-East Asia, the mechanism of angle closure appears to be more varied and complex and its detection may require more elaborate imaging.
The mechanism of angle closure and potential for prevention by screening are likely to have to be determined specifically for each population at risk.
青光眼是继白内障之后导致全球失明的第二大原因。约半数青光眼被认为是原发性闭角型青光眼（ACG）。本综述探讨ACG能否在人群层面得到预防。
回顾来自格陵兰、加拿大和阿拉斯加因纽特人的已发表信息，以及对蒙古、中国和东南亚亚洲人群近期研究的描述。
格陵兰因纽特人的前房深度（ACD）是目前有记录以来最浅的。通过对年长因纽特人进行中央ACD的系统光学测量和范氏试验，随后在必要时进行前房角镜检查及预防性虹膜切除术或激光虹膜切开术，37年间因ACG导致的失明比例从64%降至9%。在蒙古，中央ACD的超声测量作为一种筛查试验具有良好的敏感性和特异性。一项关于筛查和预防性激光治疗的随机对照试验即将完成。在中国和东南亚，房角关闭的机制似乎更多样和复杂，其检测可能需要更精细的成像检查。
房角关闭的机制以及通过筛查进行预防的可能性可能需要针对每个高危人群具体确定。
