The pathogenesis of PCG is uncertain. Clinically, the angle appears immature, which is thought to result from arrested maturation of tissues from neural crest–derived cells. This in turn is thought to cause increased resistance to aqueous outflow through the trabecular meshwork. Ophthalmologist Otto Barkan hypothesized that this resistance was caused by a membrane covering the anterior chamber angle. Although this membrane has never been identified, individuals with PCG have a developmental anomaly of the anterior chamber angle, with dysgenesis and compression of the trabecular meshwork and an anterior insertion of the iris root (Fig 1-11). In cases with mutations in ANGPT1 or TEK, the etiology is thought to be due to maldevelopment of Schlemm canal.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.