Genetics of closed-angle glaucoma.

Acute inflammatory or congestive glaucoma was recognized in ancient times as an entity and well it might be in view of its dramatic symptoms and extreme pain. In 1857 von Graefe described its symptomatology in modem language and recognized it as a primary form of glaucoma in the adult. Among other features he noted that a characteristic of the eye so affected was shallowness of the anterior chamber, an observation that was reaffirmed in 1887 by Priestley Smith. Early attempts to separate the primary glaucomas by measurement of the chamber depth failed because of poor technique and because, as we know, a shallow chamber is not pathognomonic of closed-angle glaucoma but is present in a significant percentage of eyes suffering from glaucoma simplex (Raeder, 1923: Rosengren, 1931). Classification of the two primary glaucomas of the adult on a structural basis had to await the gonioscopic studies of Barkan (1936, 1941) who found that the width of the chamber angle was all important. An eye subject to acute or subacute glaucoma was invariably found to have a narrow angle associated with a shallow anterior chamber. Between attacks the angle is open and during attacks it is closed (Bangerter and Goldmann, 1941). Thus Barkan, working entirely on his own with a Koeppe lens bought in Europe and a slit-lamp binocular microscope, modified to hang from the ceiling of his office in San Francisco, established the mechanism of inflammatory or congestive glaucoma by careful observation of his patients in private practice. The hereditary background of this type of glaucoma interested him for he not only noticed that his patients displayed a familial incidence but also that 'other members of the family even if not suffering from increased pressure have characteristic shallow chambers and narrow angles'. It may be stated with some truth that all later work on the genetics of closed-angle glaucoma is a refinement and an elaboration of this observation. Many observers, of course, came close to Barkan's idea: von Graefe (1869) himself recognized a genetic influence in inflammatory cases and had wondered