|Year : 1971 | Volume
| Issue : 4 | Page : 169-171
MS Narankari, KK Khanna, Daljit Singh, GD Chawla
Department of Ophthalmology, Medical College, Amritsar, India
M S Narankari
Department of Ophthalmology, Medical College, Amritsar
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Narankari M S, Khanna K K, Singh D, Chawla G D. Ciliary synechia. Indian J Ophthalmol 1971;19:169-71
Adhesions of the anterior uvea to the surrounding structures due to organisation of cellular exudates indicates old inflammatory involvement of this tissue. Though any portion of the iris and ciliary body can be involved in synechia formation, the term posterior synechia usually connotes the gluing of the iris to the anterior surface of the lens. Synechia formation usually takes the following forms:
(1) Posterior Synechia: Gluing of the iris tissue to the lens which may be localised or extensive.
(2) Annular or ring synechia: When the iris around the pupil is bound down to the lens.
(3) Total posterior synechia: When the entire hosterior surface of the iris is adherent to the lens.
(4) Anterior peripheral synechia: Adhesion between the root of the iris and extreme peripheral part of the posterior surface of the cornea.
As in the case of iritis adhesions of the ciliary body to the lens can occur in cyclitis. Fuchs (1884) described that in cyclitis the ciliary processes get swollen, sometimes sufficiently enough to touch the lens, but ciliary synechia i.e., adhesions of the ciliary processes with the equator of the lens have not so far been described in the literature. This paper presents hitherto unknown clinical entity of ciliary synechia.
| Observations|| |
Material comprised 315 patients with mature senile cataract. Each case underwent thorough examination including oblique illumination, slit lamp, tonometry, pupillary reactions, state of visual acuity and type of cataract. Cases with uncomplicated mature senile cataract in whom a successful intracapsular delivery of the lens was expected, were included in the study.
In 3% of the cases of this study we felt unexpexted difficulty in extracting the lens. On inspecting the extracted lens we could attribute the difficulty in extraction of the lens to the adhesions of the equator of the lens to the ciliary body. These ciliary synechia were seen in the following forms:
(1) A broad patch of pigment at the equator
(2) Broad patches of pigmentation, the equatorial ends of which were flanked by striate pigmentation
(3) In the form of striations over a small sector of the equator of the lens
The following chart shows the age, type of cataract and postoperative behaviour of nine cases of ciliary synechia in a series of 315 cases, of intracapsular cataract extraction [Table - 1].
| Discussion|| |
The lens suspended on all sides by zonular fibres is situated at a distance of about 0.5 mm. from the ciliary processes. Adhesion between the equator of lens and ciliary processes is certainly due to contact and gluing of the two structures with each other. Such a possibility can arise under three circumstances:
(a) Mild chronic sub-clinical cyclitis leading to swelling of the ciliary processes sufficient enough to touch the lens. The disease may be so mild that exudation is sparse, limiting itself to microscopical dimensions, hence eluding detection. Whether the cataract is due to mild cyclitis or mild cyclitis is consequential to lens changes, is difficult to assess.
(b) Swelling of the lens in intumescent and Morgagnian stages of cataract formation can lead to contact between the equator of the lens and the ciliary processes particularly in the lower portion because of gravitational factors. Long continued contact can lead to synechiae formation.
(c) Mild subclinical phakogenic cyclitis leading to synechia formation.
Whatever the cause, when these adhesions are forcibly broken, the posterior layer of pigment epithelium femains attached to the lens, while the anterior layer is torn away from it, revealing the presence of ciliary synechiae.
Although the number of cases in the series is too small for a statistical analysis, we are inclined to feel that the incidence of postoperative iritis and the disturbance of anterior face of vitreous is higher in such cases. In our opinion the incidence of ciliary synechiae is more than 3%, because unsuccessful intracapsular extractions are not included. We also feel that most of the cases of ruptured capsule in which no apparent causes like posterior synechiae, intumescent lens, thin degenerated capsule are present, are due to the presence of ciliary synechiae.
| Summary|| |
A new variety of synechia between the ciliary processes and the equator of lens is described. Its incidence, aetiology, and its bearing on cataract extraction are discussed.
| References|| |
FUCHS, J. (1884) quoted by DukeElder, Text Book of Ophthalmology Vol. III, Henry Kimpton, London, 1940.
[Table - 1]