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.

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.