University of North Carolina School of Medicine.
Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Curr Opin Ophthalmol. 2022 Mar 1;33(2):97-102. doi: 10.1097/ICU.0000000000000813.
The aim of this article is to summarize up-to-date research on the diagnosis and management of juvenile open-angle glaucoma (JOAG).
JOAG can be subclassified into four clinical phenotypes, and faster myopic shift is a risk factor for disease progression. Vessel density is associated with structural damage and worsening visual acuity in JOAG and can be monitored with optical coherence tomography angiography. Genetic studies have revealed molecular causes of JOAG including variants in CPAMD8, MYOC, and CYP1B1. Tube shunt surgeries as well as gonioscopy-assisted transluminal trabeculotomy have been shown to be successful in JOAG.
Although genetic advances may improve future screening, intraocular pressure monitoring and fundoscopic exam remain the current mainstay of diagnosis. Medical treatment alone for JOAG is typically insufficient with patients requiring surgical management. Selective laser trabeculoplasty may delay or decrease the need for surgery. Trabeculectomy has traditionally been shown to be effective in JOAG, but tube shunt surgery and microinvasive glaucoma surgery are effective alternatives.
本文旨在总结青少年开角型青光眼（JOAG）的最新诊断和治疗研究进展。
JOAG 可分为四个临床表型，近视进展较快是疾病进展的危险因素。血管密度与 JOAG 的结构损伤和视力下降有关，可通过光相干断层扫描血管造影进行监测。遗传研究揭示了 JOAG 的分子病因，包括 CPAMD8、MYOC 和 CYP1B1 等基因的变异。引流管手术以及房角切开术辅助经巩膜隧道小梁切开术已被证明对 JOAG 有效。
尽管遗传进展可能改善未来的筛查，但眼压监测和眼底检查仍然是目前诊断的主要手段。JOAG 患者仅通过药物治疗通常是不够的，需要手术治疗。选择性激光小梁成形术可能会延迟或减少手术需求。小梁切除术已被证明对 JOAG 有效，但引流管手术和微创青光眼手术是有效的替代方法。
