Abstract
Purpose
To report a series of cases and microsurgical management of rarely occurring uveitis-glaucoma-hyphema (UGH) syndrome in patients with single-piece acrylic intraocular lens (IOL) placed in the capsular bag.
Methods
It was a series of patients with UGH syndrome induced by posterior chamber IOL/capsular bag complex instability (pseudophakodonesis), who underwent IOL fixation to the iris. Visual acuity, intraocular pressure, number of glaucoma medications and IOL status (position) were recorded by the same protocol before and 6 months after the surgical treatment.
Results
The case series presents three patients with UGH syndrome caused by single-piece acrylic IOL placed in-the-bag. Each patient had uneventful phacoemulsification with posterior chamber IOL implantation few years ago and pseudophakodonesis caused by weakened zonules from pseudoexfoliation with subsequent development of UGH syndrome. IOL fixation to the iris with satisfactory postoperative results was performed due to the development of UGH. Signs of syndrome did not recur 6 months after the operation.
Conclusion
UGH syndrome can be induced by unstable in-the-bag IOL due to zonular laxity. Depending on the severity of the syndrome, this condition can be fought by applying a minimally invasive approach—IOL suturing to the iris with direct observation under the surgical microscope precisely in the anticipated location with no or minimal pupil deformation. Symptoms of UGH did not recur due to increased stability of the IOL and, as a result of this, declined irritation of the uveal tissue.
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References
Bryant TK, Feinberg EE, Peeler CE (2017) Uveitis–glaucoma–hyphema syndrome secondary to a Soemmerring ring. J Cataract Refract Surg 43:985–987. https://doi.org/10.1016/j.jcrs.2017.07.002
Ellingson FT (1978) The uveitis–glaucoma–hyphema syndrome associated with the Mark VIII anterior chamber lens implant. J Am Intraocular Implant Soc 4:50–53
Sousa DC, Leal I, Faria MY, Pinto LA (2016) A rare manifestation of uveitis–glaucoma–hyphema syndrome. J Curr Glaucoma Pract 10:76–78. https://doi.org/10.5005/jp-journals-10008-1205
Apple DJ, Mamalis N, Loftfield K et al (1984) Complications of intraocular lenses. A historical and histopathological review. Surv Ophthalmol 29:1–54
Davies EC, Pineda R II (2016) Intraocular lens exchange surgery at a tertiary referral center: indications, complications, and visual outcomes. J Cataract Refract Surg 42:1262–1267. https://doi.org/10.1016/j.jcrs.2016.06.031
Arthur SN, Wright MM, Kramarevsky N et al (2009) Uveitis–glaucoma–hyphema syndrome and corneal decompensation in association with cosmetic iris implants. Am J Ophthalmol 148:790–793. https://doi.org/10.1016/j.ajo.2009.06.008
Van Liefferinge T, Van Oye R, Kestelyn P (1994) Uveitis–glaucoma–hyphema syndrome: a late complication of posterior chamber lenses. Bull Soc Belge Ophtalmol 252:61–65 (discussion 66)
Boutboul S, Letaief I, Lalloum F et al (2008) Pigmentary glaucoma secondary to in-the-bag intraocular lens implantation. J Cataract Refract Surg 34:1595–1597. https://doi.org/10.1016/j.jcrs.2008.04.054
Foroozan R, Tabas JG, Moster ML (2003) Recurrent microhyphema despite intracapsular fixation of a posterior chamber intraocular lens. J Cataract Refract Surg 29:1632–1635
Menapace R (2016) Peripheral iris transillumination defect and recurrent anterior chamber bleeding with bag-fixated intraocular lens: November consultation #1. J Cataract Refract Surg 42:1686. https://doi.org/10.1016/j.jcrs.2016.11.010
Zhang L, Hood CT, Vrabec JP et al (2014) Mechanisms for in-the-bag uveitis–glaucoma–hyphema syndrome. J Cataract Refract Surg. https://doi.org/10.1016/j.jcrs.2013.12.002
Mamalis N (2000) Explantation of intraocular lenses. Curr Opin Ophthalmol 11:289–295
Van Mierlo C, Pinto LA, Stalmans I (2015) Surgical management of iatrogenic pigment dispersion glaucoma case series. J Curr Glaucoma Pract 9:28–32. https://doi.org/10.5005/jp-journals-10008-1180
Zemba M, Camburu G (2017) Uveitis–glaucoma–hyphaema syndrome. General review. Rom J Ophthalmol 61:11–17. https://doi.org/10.22336/rjo.2017.3
Walland MJF (2017) Uveitis–glaucoma–hyphaema (UGH) syndrome treated with local laser iridoplasty. Clin Exp Ophthalmol 45:647–648. https://doi.org/10.1111/ceo.12928
Rech L, Heckler L, Damji KF (2014) Serial intracameral bevacizumab for uveitis–glaucoma–hyphema syndrome: a case report. Can J Ophthalmol 49:e160–e162. https://doi.org/10.1016/j.jcjo.2014.09.010
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
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Poster: The XXXV Congress of the European Society of Cataract and Refractive Surgeons, October 2017, Lisbon, Portugal.
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Jasinskas, V., Vaiciuliene, R., Varoniukaite, A. et al. Novel microsurgical management of uveitis-glaucoma-hyphema syndrome. Int Ophthalmol 39, 1607–1612 (2019). https://doi.org/10.1007/s10792-018-0972-5
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DOI: https://doi.org/10.1007/s10792-018-0972-5