title: Primary angle closure glaucoma: What we know and what we don't know.
abstract: 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.
authors.affiliation: 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. Electronic address: xhsun@shmu.edu.cn.
authors.forename: Xinghuai
authors.initials: X
authors.lastname: Sun
authors.affiliation: 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.
authors.forename: Yi
authors.initials: Y
authors.lastname: Dai
authors.affiliation: 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.
authors.forename: Yuhong
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia; Lions Eye Institute, The University of Western Australia, Perth, Australia.
authors.forename: Dao-Yi
authors.initials: DY
authors.lastname: Yu
authors.affiliation: Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia; Lions Eye Institute, The University of Western Australia, Perth, Australia.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Cringle
authors.affiliation: 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.
authors.forename: Junyi
authors.initials: J
authors.lastname: Chen
authors.affiliation: 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.
authors.forename: Xiangmei
authors.initials: X
authors.lastname: Kong
authors.affiliation: 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.
authors.forename: Xiaolei
authors.initials: X
authors.lastname: Wang
authors.affiliation: 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.
authors.forename: Chunhui
authors.initials: C
authors.lastname: Jiang
mesh_terms: D003941:Diagnostic Techniques, Ophthalmological; D019468:Disease Management; D015812:Glaucoma, Angle-Closure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D013564:Sympathetic Nervous System / Q000503:physiopathology*
keywords: Diagnosis; Nomenclature; Pathogenesis; Primary angle closure glaucoma; Treatments