PERIPHERAL ANTERIOR

SYNECHIAE (PAS)
EXAMINATION
FELICHIA YOVIANDA
GLAUCOMA SUB-DIVISION
MEDICAL FACULTY ANDALAS UNIVERSITY
RSUP DR M.DJAMIL PADANG
MARCH 2016
 INTRODUCTION

Trantas 1907 anterior chamber formed when endotel

cornea meets anterior of iris and consits of trabecular
meshwork.

Barkan 1938 located of Peripheral Anterior Synechiae

(PAS) between peripheral iris and trabecular meshwork
trigger for decreased intraoculer pressure and
predisposition for glaucoma.
 ANTERIOR CHAMBER
Production and outflow of aqueous humor:
Non-pigmented epithelium ciliary camera oculi
posterior (COP) pupil camera oculi anterior
(COA) trabecular meshwork schlemms canal
episcleral vein
Structure of anterior chamber angle:
1. Schwalbe line (SL)
2. Canal schlemm & Trabecular meshwork (TM)
3. Scleral spur (SS)
4. Ciliary body band (CBB)
5. Processus iris (PI)
PERIPHERAL ANTERIOR SYNECHIAE (PAS)
Definition: a condition in which
the iris adherens to anterior
chamber angle.

Predisposition:
1. Race: Asia >>
2. Age
3. Sex: Female >>
4. Repeat or prolonged angle
closure attack
5. Inflamation
 PAS MECHANISM
1. Proliferative
Inflamation in COA (uveitis, ICE syndrome,
neovascular glaucoma, post laser trabeculoplasty)
fibrovascular membrane between iris & trabecular
meshwork anterior pulling mechanism
 Central retinal vena occlusion & diabetic
retinopathy retina ischemic produced VEGF &
IL-6 form neovascularization & fibrovascular
membran at anterior segment contraction of
membrane form PAS

Uveitis produced inflamation mediator

accumulation inflamation cell, debris and protein
serum in trabecula trabeculitis & COA angle
adhesion of iris form PAS
Iridocorneal endothelial
(ICE) syndrome, 3 triase:
1. Iris atrophy
2. Corneal edema
3. Secondary closure
glaucoma without pupil
block

ICE syndrome: defect in

endotel cornea cornea
edema & form membrane
contraction of
membrane form PAS
2. Non-proliferative
Pupillary block trabecular meshwork fight
the pressure can make aposition iris
posterior pushing mechanism
 PAS CLASSIFICATION
Based on iris adhesion:
Narrow PAS : < 150
Medium PAS : 150 - 300
Board PAS : > 300

Inoue et al describes 12 zone of PAS:

Zone 12 and 1 : superior
Zone 2 5 : nasal
Zone 6 and 7 : inferior
Zone 8 11: temporal
 PAS EXAMINATION
1. INDIRECT GONIOSCOPY
gold standard for assement depth of COA angle
patient with primery position in slitlamp, invasif
use Goldmann, Posner, Sussman and Zein lens
 If ciliary body band (CBB) and scleral spur (SS)
visible in gonioscopy indirect open angle

If SS and trabecular meshwork (TM) not visible in

gonioscopy indirect narrow angle
gonioscopy indentation for detection aposisition or
peripheral anterior synechiae (PAS)
2. ULTRASOUND BIOMICROSCOPY (UBM)

Anterior segment examination for describes

camera oculi anterior and posterior (COA & COP)
Used higher ultrasound frequency, invasif
UBM do in dark situation or no light
Scleral spur (SS) is referential point for assement
anterior chamber
Aposisition

PAS
3. ANTERIOR SEGMENT OPTICAL COHERENCE
TOMOGRAPHY (AS-OCT)
Objective, non-invasif for visualization between
cornea and COA angle used diode laser
Scleral spur (SS) anatomical landmark
 AS OCT

Peripheral Anterior
Synechiae (PAS)
 CONCLUSION
Peripheral anterior synechiae (PAS) adhesion
iris to COA angle, permanent obstruction aquos
humor outflow
PAS associated with abnormal condition, such as:
neovascular glaucoma, inflamation, ICE syndrome,
post traumatic
2 mechanism to form PAS: anterior pulling
mechanism & posterior pushing mechanism
Indirect & indentation gonioscopy, ultrasound
biomicroscopy (UBM) and anterior segment optical
coherence tomography (AS-OCT) examination
to define PAS
THANK YOU
Scheie
Becker
&
Shaffer
Spaeth
PARAMETER UBM & AS-OCT
AS-OCT vs UBM