obsolete Posterior synechiae

Posterior Synechiae: An Obsolete Condition

Posterior synechiae, also known as iridolenticular adhesions, is a condition where the iris adheres to the lens in the eye. This type of synechiae was once considered a significant complication of cataract surgery, but it has become relatively rare with advancements in surgical techniques.

Characteristics

Posterior synechiae can occur due to inflammation or as a result of chronic uveitis. The adhesions between the iris and lens can prevent the pupil from dilating properly, leading to irregular pupil shape and potentially causing angle closure glaucoma (1). In some cases, posterior synechiae may be accompanied by other complications such as Descemet membrane detachment (DMD) or posterior capsule rent (PCR) (7)(9).

Incidence

While posterior synechiae are still a concern in certain eye conditions, they have become relatively rare with modern surgical techniques. According to some studies, posterior synechiae occur in only 0.5% to 7.5% of cataract surgery cases (9). However, in cases of chronic or recurrent anterior uveitis, posterior synechiae are the most common ocular complications, affecting up to 91% of affected eyes (15).

Treatment

The treatment for posterior synechiae depends on the underlying cause and severity of the condition. In some cases, surgical intervention may be necessary to break down the adhesions between the iris and lens.

References:

• [1] Context result 3
• [7] Context result 7
• [9] Context result 9
• [15] Context result 15

Posterior synechiae, also known as posterior synechia or iris adhesions, refer to the adhesion of the iris to the lens in the eye. While this condition is not commonly diagnosed today due to advancements in medical technology and treatments, there are still some diagnostic tests that can be used to identify it.

• Visual examination: A thorough visual examination by an ophthalmologist or optometrist is often sufficient to diagnose posterior synechiae. The presence of adhesions between the iris and lens can be visually apparent, especially if they are extensive [8].
• Slit lamp exam: A slit lamp exam is a detailed examination of the eye that uses a special microscope to magnify the structures inside the eye. This test can help identify posterior synechiae by allowing the examiner to see the adhesions between the iris and lens more clearly [1].
• Gonioscopy: Gonioscopy is a diagnostic test that allows the examiner to view the angle of the anterior chamber, where the iris meets the cornea. This test can be used to diagnose posterior synechiae by identifying adhesions between the iris and lens in this area [1].

It's worth noting that these diagnostic tests are not as commonly used today due to advancements in medical technology and treatments for posterior synechiae. However, they may still be useful in certain cases or when other diagnostic tests are inconclusive.

References:

[1] Context result 1: Diagnosis is made with slit lamp exam and with gonioscopy of angle structures. [8] Context result 8: Jan 27, 2024 — Synechiae is often visually apparent, so a visual ophthalmic examination is usually enough for a diagnosis.

Treatment Options for Obsolete Posterior Synechiae

Posterior synechiae, a complication of uveitis, can be challenging to treat. However, various medications have been used to prevent or break these adhesions. Here are some treatment options:

• Cycloplegics: These medications, such as cyclopentolate (1)[11], can be used to prevent posterior synechiae between the lens and the iris in anterior uveitis.
• Mydriatic and Cycloplegic Agents: These agents can help break posterior synechiae and prevent complications like glaucoma and vision loss (3).
• Steroids: Topical steroids, such as prednisolone acetate (12), can be used to minimize inflammation and prevent PAS formation (7). However, their use may have limitations, especially in susceptible patients.
• Corticosteroids: In mild cases, initial treatment with corticosteroids like prednisolone may suffice. However, if the patient does not respond, more aggressive approaches may be necessary (10).

Important Considerations

When treating posterior synechiae, it's essential to consider the potential risks and benefits of each medication. For example, while cycloplegics can prevent posterior synechiae, they may also have adverse effects in susceptible patients.

References:

[1] Context 11 [3] Context 3 [7] Context 7 [10] Context 10 [11] Context 11

Based on the provided context, it appears that posterior synechiae can be associated with several conditions. Here are some possible differential diagnoses for obsolete posterior synechiae:

• Occlusio pupillae: This is a condition where the pupil becomes blocked or occluded due to adhesions between the iris and the lens (1).
• Peripheral anterior synechiae: These are adhesions that form between the cornea and the iris, which can be a complication of childhood uveitis (3).
• Posterior pupillary synechiae: This condition affects a proportion of eyes subjected to iridectomy with or without drainage operation, where aqueous humour bypasses the pupil (10).

It's worth noting that posterior synechiae can also be associated with other conditions such as ICE Syndrome, Epithelial Downgrowth, Posterior Pushing, Phacomorphic, Tumors, and Choroidal Effusions (8). However, these are not directly related to obsolete posterior synechiae.

In terms of differential diagnosis, it's essential to consider the underlying causes of posterior synechiae, such as inflammation or trauma, and rule out other conditions that may present with similar symptoms. A thorough examination and medical history would be necessary to determine the correct diagnosis (9).

References: (1) [3] (3) [3] (8) [8] (9) [9] (10) [10]