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   Table of Contents      
ARTICLES
Year : 1971  |  Volume : 19  |  Issue : 4  |  Page : 169-171

Ciliary synechia


Department of Ophthalmology, Medical College, Amritsar, India

Correspondence Address:
M S Narankari
Department of Ophthalmology, Medical College, Amritsar
India
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Source of Support: None, Conflict of Interest: None


PMID: 15745414

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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

How to cite this URL:
Narankari M S, Khanna K K, Singh D, Chawla G D. Ciliary synechia. Indian J Ophthalmol [serial online] 1971 [cited 2020 May 28];19:169-71. Available from: http://www.ijo.in/text.asp?1971/19/4/169/34972

Table 1

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Table 1

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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 Top


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 Top


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 Top


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[1].

 
  References Top

1.
FUCHS, J. (1884) quoted by Duke­Elder, Text Book of Ophthalmo­logy Vol. III, Henry Kimpton, London, 1940.  Back to cited text no. 1
    



 
 
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