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Table 1. Appearance of Peripheral Anterior Synechiae (PAS) on Gonioscopy

General Appearance	Detailed Appearance	Possible Causes
Broad bands
	PAS to all levels but not to cornea. Bridging usually not present.	Angle-closure glaucoma
	PAS to all levels, sometimes to cornea. Bridging may be present.	Posterior pushing mechanism, post-operative shallow anterior chamber, or iris bombé
	PAS with new vessels, multiple sites	Neovascularization
Scattered, irregular
	PAS tent and form columns up to, but not on, the cornea	Iridocyclitis with keratic and trabecular precipitates
	Small PAS to scleral spur	Post-argon laser trabeculoplasty

Table 2. Summary of Important Causes of Peripheral Anterior Synechiae by Mechanism

Iris Pulled Forward

Iris Pushed Forward

Neovascular membrane

Iridocorneal endothelial membrane

Posterior polymorphous dystrophy

Epithelial/fibrous ingrowth

Uveitis

Trauma

Inflammatory syndromes

Infection

Flat anterior chamber

Post-surgical

Trauma

Post-laser trabeculoplasty

Pupil block

Primary angle-closure glaucoma

Posterior synechiae resulting in iris bombé

Pseudophakic or aphakic pupil block

Iridoschisis

Plateau iris

Choroidal or supraciliary effusion

- Posterior uveitis

- Central retinal vein occlusion

- Nanophthalmos

- Post-panretinal photocoagulation or cryotherapy

Suprachoroidal hemorrhage

Aqueous misdirection syndrome

Posterior segment tumors

- Retinoblastoma

- Choroidal melanoma

- Metastasis

Iris cyst or tumor

Ciliary body cyst or tumor

Contracting retrolental tissue

- Retinopathy of prematurity

- Persistent hyperplastic primary vitreous

Post-scleral bucking surgery

Anterior lens subluxation (ectopia lentis)

Lens intumescence (phacomorphic glaucoma)

Neurofibromatosis

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Author

Maria Hannah Pia U de Guzman, MD, DPBO, FPAO Consultant, Department of Ophthalmology, Glaucoma Section, Asian Hospital and Medical Center; Consultant, Eye Institute, Glaucoma Service, St Luke’s Medical Center, Philippines

Maria Hannah Pia U de Guzman, MD, DPBO, FPAO is a member of the following medical societies: Philippine Academy of Ophthalmology, Philippine Glaucoma Society, Philippine Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

J James Rowsey, MD Former Director of Corneal Services, St Luke's Cataract and Laser Institute

J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Sigma Xi, The Scientific Research Honor Society, Southern Medical Association, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD † Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Bradford Shingleton, MD Assistant Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary

Bradford Shingleton, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Iqbal Ike K Ahmed, MD, FRCSC Clinical Assistant Professor, Department of Ophthalmology, University of Utah

Iqbal Ike K Ahmed, MD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Canadian Ophthalmological Society, Ontario Medical Association

Disclosure: Nothing to disclose.

Baseer U Khan, MD

Baseer U Khan, MD is a member of the following medical societies: Canadian Ophthalmological Society

Disclosure: Nothing to disclose.

Khalid Hasanee, MD Glaucoma and Anterior Segment Fellow, Department of Ophthalmology, University of Toronto

Khalid Hasanee, MD is a member of the following medical societies: Canadian Medical Association, Canadian Ophthalmological Society, Ontario Medical Association

Disclosure: Nothing to disclose.

Andrew J Tatham, MD, MBA, FRCOphth, FEBO, FRCS(Ed) Consultant Ophthalmic Surgeon, Princess Alexandra Eye Pavilion; Honorary Senior Clinical Lecturer, University of Edinburgh; NHS Scotland Career Research Fellow

Andrew J Tatham, MD, MBA, FRCOphth, FEBO, FRCS(Ed) is a member of the following medical societies: American Glaucoma Society, Association for Research in Vision and Ophthalmology, Royal College of Ophthalmologists, Royal College of Surgeons of Edinburgh, UK and Eire Glaucoma Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Allergan; Santen; Thea; Glaukos<br/>Serve(d) as a speaker or a member of a speakers bureau for: Allergan; Heidelberg Engineering; Alcon; Santen.

Peripheral Anterior Synechia Differential Diagnoses

Differential Diagnoses

Peripheral Anterior Synechia Differential Diagnoses

Differential Diagnoses

References

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