Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, China; Key Laboratory of Myopia of State Health Ministry (Fudan University) and Key Laboratory of Visual Impairment and Restoration of Shanghai, China; State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Fudan University, China.
Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, China; Key Laboratory of Myopia of State Health Ministry (Fudan University) and Key Laboratory of Visual Impairment and Restoration of Shanghai, China.
Prog Retin Eye Res. 2017 Mar;57:26-45. doi: 10.1016/j.preteyeres.2016.12.003. Epub 2016 Dec 28.
Primary angle-closure glaucoma (PACG) is a common cause of blindness. Angle closure is a fundamental pathologic process in PAGC. With the development of imaging devices for the anterior segment of the eye, a better understanding of the pathogenesis of angle closure has been reached. Aside from pupillary block and plateau iris, multiple-mechanisms are more common contributors for closure of the angle such as choroidal thickness and uveal expansion, which may be responsible for the presenting features of PACG. Recent Genome Wide Association Studies identified several new PACG loci and genes, which may shed light on the molecular mechanisms of PACG. The current classification systems of PACG remain controversial. Focusing the anterior chamber angle is a principal management strategy for PACG. Treatments to open the angle or halt the angle closure process such as laser peripheral iridotomy and/or iridoplasty, as well as cataract extraction, are proving their effectiveness. PACG may be preventable in the early stages if future research can identify which kind of angles and/or persons are more likely to benefit from prophylactic treatment. New treatment strategies like adjusting the psychological status and balancing the sympathetic-parasympathetic nerve activity, and innovative medicines are needed to improve the prognosis of PACG. In this review, we intend to describe current understanding and unknown aspects of PACG, and to share the clinical experience and viewpoints of the authors.
原发性闭角型青光眼（PACG）是一种常见的致盲眼病。房角关闭是 PACG 的基本病理过程。随着眼前节成像设备的发展，人们对房角关闭的发病机制有了更好的认识。除瞳孔阻滞和高褶虹膜外，脉络膜厚度和葡萄膜扩张等多种机制也更常见于房角关闭，这可能是 PACG 临床表现的原因。最近的全基因组关联研究确定了几个新的 PACG 位点和基因，这可能有助于阐明 PACG 的分子机制。目前的 PACG 分类系统仍存在争议。前房角聚焦是 PACG 的主要治疗策略。通过激光周边虹膜切开术和/或虹膜成形术以及白内障摘除术来开放房角或阻止房角关闭过程，这些治疗方法已被证明是有效的。如果未来的研究能够确定哪种类型的房角和/或患者更有可能从预防性治疗中获益，PACG 可能在早期得到预防。需要新的治疗策略，如调整心理状态和平衡交感神经-副交感神经活性，以及创新药物，以改善 PACG 的预后。在这篇综述中，我们旨在描述 PACG 的现有认识和未知方面，并分享作者的临床经验和观点。
