What is the role of medications in the treatment of peripheral anterior synechiae (PAS)?

Updated: Mar 19, 2021
  • Author: Maria Hannah Pia U de Guzman, MD, DPBO, FPAO; Chief Editor: Hampton Roy, Sr, MD  more...
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Answer

The following drug categories may be considered, depending on the primary diagnosis: topical β-blockers, topical α-agonists, topical carbonic anhydrase inhibitors, oral carbonic anhydrase inhibitors, topical prostaglandin agonists, miotics, cycloplegics, and topical corticosteroids.

Treat elevated intraocular pressure, as necessary.

  • Topical α-agonists, β-blockers, carbonic anhydrase inhibitors, and prostaglandin agonists may be useful in lowering intraocular pressure in eyes with PAS.
  • Miotics are useful in the treatment of pupil block due to primary angle-closure but may exacerbate angle closure due to posterior pushing mechanisms.
  • Miotics or prostaglandin analogs are unlikely to be useful in cases in which the PAS extent is 360 degrees.

Treat inflammation, as necessary.

  • Topical steroids minimize inflammation and, therefore, PAS formation.
  • Cycloplegics should be used to prevent formation of posterior synechiae.
  • Miotics and epinephrine should be avoided because they can increase inflammation.

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