Peripheral anterior synechia overlying the haptics of posterior chamber lenses. Occurrence and natural history.

Sixty consecutive eyes that met the standard criteria for cataract surgery underwent phacoemulsification with insertion of a posterior chamber lens implant. The filtration angle of each eye was examined with routine postoperative gonioscopy in a prospective manner. Peripheral anterior synechia (PAS) overlying the position of the lens haptic (lens haptic PAS) were observed in up to 80% of eyes implanted with haptics vaulted anteriorly by 10 degrees. The rate of occurrence of lens haptic PAS was reduced by a statistically significant level in a group of eyes implanted with nonvaulted haptics. Most of the lens haptic PAS were observed early in the postoperative period and remained stable in size. Progression in size was noted quantitatively in three eyes and documented with goniophotography in two eyes. A delay in the presentation of lens haptic PAS was observed in seven eyes. A postoperative increase in intraocular pressure (IOP) associated with enlargement of lens haptic PAS developed in one patient with preoperative chronic open-angle glaucoma. These observations support others that progressive PAS overlying posterior chamber lens haptics can be a form of progressive angle-closure glaucoma in pseudophakia. This mechanism may be more likely to occur in eyes implanted with anterior vaulted haptics.