Recurrent Uveitis-Glaucoma-Hyphema Syndrome Due to Positional Pupillary Capture after Sutureless Scleral-Fixated Secondary Intraocular Lens Placement

Abstract

Here, we present a case of floppy iris leading to positional pupillary capture by a sutureless, scleral-fixated intraocular lens (IOL) causing recurrent uveitis-glaucoma-hyphema (UGH) syndrome. The patient developed recurrent episodes of UGH syndrome after dislocated IOL removal and the placement of sutureless, scleral-fixated IOL. Gravitationally dependent pupillary capture was noted with the superior iris moving in front of and behind the IOL, depending on head positioning. Ultrasonography showed a floppy iris that moved with shifting gaze. The lack of the capsular bag may have contributed to extreme iris movements. This finding may be secondary to a combination of a lack of zonular support and capsular bag support as well as the lack of vitreous support following vitrectomy. When possible, secondary IOL placement behind a peripherally preserved capsular bag may reduce the risk of UGH.