原发性闭角型青光眼发病因素的再认识

New understandings of the pathogenesis of primary angle-closure glaucoma

原发性闭角型青光眼(PACG)目前仍是我国常见的致盲眼病之一,因为其视力丧失的不可逆性,所以早期影响青光眼发生和发展的因素倍受关注。人们对浅前房、短眼轴、厚虹膜及大而前置的晶状体等高危眼前节静态解剖结构的认识并不能完全解释PACG转化的过程,所以要进一步考虑眼部结构动态改变在青光眼发生和发展中的具体作用。本文阐述了正常人和PACG患者虹膜体积和弹性的动态变化过程,晶状体在眼球发育过程中与眼球内结构的不协调性,睫状体、玻璃体和脉络膜发生的动态阻滞与扩张,以及眼部神经和血管系统异常调节及变化与PACG发病之间关系的最新研究,以期为深刻认识PACG的发病机制、临床的精准诊断和治疗策略的制定提供指导。

Primary angle-closure glaucoma(PACG)is still one of the common blinding eye diseases in China.Because of the irreversibility of the vision loss it caused,the factors affecting the early development of glaucoma are of great concern.The understanding of static anatomic structure of high-risk anterior segment,such as shallow anterior chamber,short axial length,thick iris and large anterior lens cannot fully explain the transformation process of PACG,so the specific role of dynamic changes in the development of glaucoma should be further considered.This article expounded the differences in iris volume and dynamic process of elasticity between normal people and patients with PACG,the incoordination between lens and intraocular structure during eyeball development,the dynamic block and expansion of ciliary body,vitreous and choroid,and the latest research on the relationship between the abnormal ocular nerve and vascular system adjustment and change with the onset of PACG,in order to provide guidance for understanding the pathogenesis of PACG,accurate clinical diagnosis and formulation of treatment strategies.