Further Outpatient Care
Further care depends on the disease process that leads to peripheral anterior synechiae (PAS) formation.
Deterrence/Prevention
Appropriate and timely management of the disease process that can lead to PAS is necessary to prevent PAS from forming or progressing. This is the most important aspect of management because once PAS have formed treatment shifts to managing the sequela of PAS, intraocular pressure elevation, rather than the PAS itself.
Complications
Complications include elevated intraocular pressure leading to ocular pain, decreased visual acuity, and glaucomatous optic neuropathy with vision loss.
Prognosis
Peripheral anterior synechiae should be treated within 6 months of formation if the trabecular meshwork is to regain normal function [8] . Beyond this, the trabecular meshwork will have sustained permanent damage.
Ultimately, prognosis depends on the adequacy of management of the etiologic process that led to PAS formation.
Eyes with 360 degrees of PAS are unlikely to be treated adequately with medications and are likely to require a glaucoma filtering procedure.
Patient Education
Patient education depends on the disease process that led to PAS formation. Emphasis must be placed on the necessity of prompt treatment to prevent the progression of the condition.
Tables
General Appearance |
Detailed Appearance |
Possible Causes |
Broad bands |
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PAS to all levels but not to cornea. Bridging usually not present. |
Angle-closure glaucoma |
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PAS to all levels, sometimes to cornea. Bridging may be present. |
Posterior pushing mechanism, post-operative shallow anterior chamber, or iris bombé |
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PAS with new vessels, multiple sites |
Neovascularization |
Scattered, irregular |
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PAS tent and form columns up to, but not on, the cornea |
Iridocyclitis with keratic and trabecular precipitates |
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Small PAS to scleral spur |
Post-argon laser trabeculoplasty |
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 |
