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Peripheral Anterior Synechiae

  • Clinical features:
    • The peripheral iris attaches anteriorly in the anterior chamber angle.
    • Attachment may extend to anterior portion of ciliary body, scleral spur, corneoscleral trabecular meshwork, Schwalbe's line or to cornea.
    • May be localized or broad and extensive.
    • May cause acute-angle closure glaucoma.
    • Secondary shallowing of the anterior chamber and resulting blockage of aqueous outflow via the trabecular meshwork may cause chronic angle-closure glaucoma.
    • Sometimes is confused with a normal prominent uveal meshwork (i.e. iris processes).
  • May develop in association with a number of ocular conditions such as neovascular glaucoma, iris bombé, heterochromic cyclitis, chronic iridocyclitis, pigmentary glaucoma, post-laser trabeculoplasty, post-scleral buckling procedure, post-trabeculectomy, ciliary body tumors, and essential iris atrophy.
  • Gonioscopic examination demonstrates a uniform and solid iris segment blocking the view of angle structure.
  • Management:
    • Peripheral laser iridotomy is recommended for patients with documented acute or subacute angle-closure glaucoma attack, persistent increase IOP and PAS without underlying secondary causes.
    • Other treatment modalities include anti-glaucoma medications, laser iridoplasty, anterior chamber paracentesis, surgical iridectomy, synechialysis, and filtration surgery.

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