Uveitis-glaucoma-hyphema Syndrome Research Articles

Uveitis-Glaucoma-Hyphema Syndrome Secondary to Implantable Collamer Lens

ABSTRACT Purpose: To report the first case of uveitis-glaucoma-hyphema (UGH) syndrome post implantable collamer lens (ICL). Methods: Case report Results: A 41-year-old female presented to our clinic complaining of bilateral eye pain and redness for two weeks. Her past medical history was significant for ICL, in both eyes and multiple sclerosis controlled with treatment. She had a long-standing history of bilateral recurrent uveitis and glaucoma. Ultrasound biomicroscopy revealed several sulcus cysts displacing the ICLs haptic into the ciliary body, leading to iris abrasion and uveitis-glaucoma-hyphema syndrome. Conclusion: We present the first published case worldwide about UGH syndrome secondary to ICL. This is an unusual complication, and measures can be taken to avoid it. This provides evidence of the importance of postoperative follow-up by the surgeon and appropriate work-up when such cases are suspected.

Anterior Segment Optical Coherence Tomography in Uveitis-Glaucoma-Hyphema Syndrome

ABSTRACT Purpose Uveitis-Glaucoma-Hyphema (UGH) syndrome results from contact between the intraocular lens (IOL) and the iris or ciliary body, leading to uveal structure erosion and blood-aqueous barrier breakdown. Treatment involves various drugs, with IOL removal often being necessary. Diagnosis relies on clinical signs, but imaging techniques like ultrasound biomicroscopy (UBM) or anterior segment optical coherence tomography (AS-OCT) are crucial. AS-OCT accurately depicts IOL position and potential contact, emerging as a primary alternative to UBM in the diagnosis. Our study aimed to correlate AS-OCT findings with clinically detectable iris atrophy in pseudophakic patients with IOL-iris chafing and UGH syndrome. Methods The study retrospectively analyzed patients diagnosed with UGH syndrome presenting at the Ocular Immunology Unit of Reggio Emilia, Italy, from January 2019 to August 2023. Patients’ data were collected. Ophthalmological exams and imaging were performed. The peephole sign in AS-OCT images was evaluated. Statistical analyses were conducted, with a significance level of p ≤ 0.05. Results The study reviewed 22 eyes of 22 patients with UGH syndrome. Four eyes were excluded, leaving 18 patients (8 females, 10 males). Common misdiagnoses included idiopathic anterior uveitis (55.5%) and herpetic anterior uveitis (16.7%). All patients had iris transillumination defects, mostly focal (77.8%). AS-OCT revealed IOL chafing in all the eyes, with peephole sign correlation. More peephole signs occurred with IOL in the sulcus (p-value = 0.08). Conclusion The study recommends AS-OCT for UGH syndrome confirmation and UBM when IOL-iris chafing is not observed on AS-OCT scans.

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

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.

Capsular bag transplantation

AbstractPurpose: To describe the surgical process of extraction of the capsular bag of the crystalline lens from the cadaveric donor and its posterior implant in aniridia and aphakia cases.Methods: This surgical procedure was used in three posttraumatic aniridia and aphakia patients, and in a aphakic case with uveitis‐glaucoma‐ hyphema (UGH) syndrome. In a case was implanted a capsular bag, an intraocular lens (IOL) and an aniridia ring. In two cases in addition was implanted an artificial iris prothesis. In three surgeries, the capsular bag was preserved by freezing prior to the operation. A pars plana vitrectomy was performed in each case. The in‐the‐bag IOL complex was fixed using a cow hitch knot technique.Results: The pseudophakic capsular bags complex remained stable and well positioned in all cases without any rejection phenomena. In the UGH syndrome, the capsular bag transplant avoided the mechanical trauma of the IOL over adjacent anatomical structures.Conclusions: Capsular bag transplant could be a good option in posttraumatic aniridia with aphakia and in UGH syndrome, to resolve these conditions in only one‐stage surgery. This new surgical technique could be the best way to recuperate the anatomical compartmentalization of the eyeball in such cases.

A Novel Application of Anterior Chamber Cells and Aqueous Humor Cytokines Analysis in Uveitis-Glaucoma-Hyphema (UGH) Syndrome: A Case Report

Background: Uveitis-glaucoma-hyphema (UGH) syndrome could be identified by clinical history and detailed ophthalmologic examination. In order to better understand the pathological processes of UGH syndrome, we introduced findings of enhanced red blood cells (RBCs) and inflammatory factors expression in a case of an UGH syndrome.

Uveitis-Glaucoma-Hyphema syndrome following sutureless scleral fixated intraocular lens: A case report

<br>Uveitis-glaucoma-hyphema (UGH) syndrome is a rare complication usually seen with anterior chamber intraocular lens. We report the occurrence of sudden-onset blurred vision and pain 1 year after an uneventful sutureless scleral fixated intraocular lens (SFIOL) implantation. Despite initial conservative management, the symptoms persisted. A recurrence of VH, uncontrolled IOP, and an irritable painful eye led to the diagnosis of UGH syndrome, and the SFIOL was explanted. We postulate a floppy iris secondary to previous trauma with resultant iris chaffing as the cause for the occurrence of UGH syndrome.<br>

The role of anterior segment optical coherence tomography in uveitis-glaucoma-hyphema syndrome.

To describe features of uveitis-glaucoma-hyphema (UGH) syndrome, using Anterior Segment-Optical Coherence Tomography (AS-OCT) and Ultrasound Biomicroscopy (UBM) and to evaluate the diagnostic role of AS-OCT as an imaging technique alternative to UBM. Retrospective case series. Four eyes of 4 patients with UGH syndrome were analyzed. All patients reported previous uncomplicated cataract surgery with in-the-bag implantation of single-piece-intraocular lens (IOL). They underwent at presentation complete ophthalmological examination and imaging with slit-lamp anterior segment photographs, UBM and AS-OCT. Although AS-OCT did not allow to visualize the structures behind the iris, it displayed a contact between IOL (plate and/or haptics) and iris and IOL tilting in 3 out of 4 eyes. AS-OCT directly detected the cause of UGH syndrome in one eye, 2 eyes required some expedients to display the iris chafing, like scans in mydriasis and/or patient's gaze direction change. AS-OCT did not allow to appreciate the IOL-iris contact (showed by UBM technique) only in one eye, probably due to the change of patient position from supine to sitting, and consequent anteriorization of iris diaphragm. Furthermore AS-OCT showed fine details, as capsular bag collapse and indirect signs of haptic malposition in 3 out of 4 eyes. AS-OCT is a non-invasive technique that allows to determine IOL position and IOL-uveal contact in selected cases of UGH syndrome. Considering AS-OCT and UBM advantages and limitations, AS-OCT should be used as first imaging modality when clinical diagnosis is uncertain. When UGH diagnosis cannot be verified using AS-OCT, UBM should be performed.

Uveitis–glaucoma–hyphema syndrome after uneventful placement of a 1-piece intraocular lens into the capsular bag

Introduction: Uveitis-glaucoma-hyphema (UGH) syndrome is an uncommon but serious complication of cataract surgery that occurs from chafing of the iris by an intraocular lens (IOL). UGH syndrome is typically associated with first-generation lenses, placement of an IOL in the ciliary sulcus, or bag-sulcus tilted positioning. UGH syndrome following placement of a modern 1-piece lens in the capsular bag is rare. Patient and clinical findings: A 55-year-old man presented with UGH syndrome 2 weeks after routine cataract surgery with in-the-bag placement of a contemporary IOL. Diagnosis, intervention, and outcomes: Correct positioning of the IOL was confirmed with ultrasound biomicroscopy and exploratory surgery, and IOL exchange achieved resolution of UGH sequelae. Conclusions: Intermittent chafing of the iris by the IOL as a result of underlying traumatic zonulopathy contributed to the development of UGH, and surgeons should be aware of this complication even with in-the-bag placement of a modern IOL.

Uveitis-Glaucoma-Hyphema Syndrome: Clinical Features and Differential Diagnosis

ABSTRACT Purpose to study the clinical features of uveitis-glaucoma-hyphema (UGH) syndrome, particularly those useful for a differential diagnosis from unilateral hypertensive acute anterior uveitis. Methods A retrospective chart review was conducted on the clinical features of 9 patients with UGH syndrome. These features were then compared with those detected in 50 patients with unilateral hypertensive acute anterior uveitis. Results Fine and pigmented keratic precipitates (p = .0002 and p = .00004, respectively), iris atrophy (p = .0122), hyphema and vitreous opacities > 2+ (p = .0003), and cystoid macular edema (p = .009) were statistically associated with UGH syndrome. These clinical signs show a high specificity, ranging from 58 to 100%; the presence of pigmented keratic precipitates in the setting of a unilateral acute hypertensive anterior uveitis has a sensitivity and specificity of 89% and 84%, respectively. Conclusion In patients operated on for cataract, UGH syndrome can be differentiated from unilateral hypertensive acute anterior uveitis considering specific clinical signs.

Repositioning surgery of different intraocular lens designs in eyes with late in-the-bag intraocular lens dislocation.

To evaluate the long-term efficacy and safety after intraocular lens (IOL) repositioning by scleral suturing of 1-piece IOL compared with other IOL designs in the treatment of late in-the-bag IOL dislocation. Patients referred to Oslo University Hospital Oslo, Norway. Prospective cohort study. The study comprised 54 patients (54 eyes) with late in-the-bag IOL dislocation treated with IOL repositioning by scleral sutures (10-0 polypropylene). All operations were performed with an anterior approach and by 1 surgeon. The following IOL designs were repositioned: 1-piece foldable (n = 17), 3-piece foldable (n = 28), plate-haptic (n = 8), and 1-piece rigid (n = 1) IOLs. Patients were evaluated comprehensively preoperatively and at 6 months (80%), 1 year (67%), and 2 years (61%) postoperatively. The main outcome measures were efficacy regarding corrected distance visual acuity (CDVA) and spherical equivalent (SE) and safety regarding complications. Postoperative visual acuity was similar for different IOL designs. The mean SE change to final observation was -0.08 (95% CI, -0.93 to 0.77) in the 1-piece IOL group (n = 11) and -0.98 (-1.73 to -0.23) in the 3-piece IOL group (n = 18) (P = .11). Regarding safety, no patients had uveitis-glaucoma-hyphema syndrome, retinal detachment, or endophthalmitis. The 3-piece IOL group had 1 case of redislocation and 1 case of iritis. No patients had symptoms related to clinical IOL decentration. Long-term intraocular pressure remained within normal limits with overlapping 95% CIs for different IOLs. Repositioning surgery of 1-piece IOLs seems as efficient and safe as that for other IOL designs in the treatment of late in-the-bag IOL dislocation.

English

BACKGROUND Secondary glaucoma is an anatomically identifiable abnormality which in turn is an underlying cause of the events that lead to aqueous outflow obstruction and rise in the intraocular pressure. This prospective study mainly highlights the secondary glaucoma with special reference to its proportion, causes and its risk factors in a tertiary care hospital. METHODS This study was a cross sectional study. Patients, who attended the Department of Ophthalmology after fulfilling the inclusion and exclusion criteria diagnosed with secondary glaucoma, were included in the study. The study period was from February 2018 to June 2020. A standard form was filled up for each patient documenting parameters and findings of various examinations and was evaluated as per protocol. RESULTS Secondary glaucoma was seen in 0.2 % patients who visited during the study period. Out of 106 patients, males were 50, females were 56, with a male: female ratio of 1:1.1. The most common cause of secondary glaucoma was lens induced glaucoma seen in 44.34 % followed by uveitic glaucoma in 20.8 % cases, traumatic 17.9 %, neovascular 10.4 %, pseudoexfoliation glaucoma 2.8 %, pigmentary glaucoma 1.9 %, silicon oil induced 0.9 %, and uveitis-glaucomahyphema syndrome in 0.9 % cases. Around thirty five percent (34.9 %) cases presented with sudden onset of painful diminution of vision with nausea and vomiting. CONCLUSIONS Secondary glaucoma is still one of the prevalent diseases in this part of country. Lens induced glaucoma is still the most common cause of secondary glaucoma. Hypermature cataract, uveitis, trauma and neovascularisation are the different risk factors. KEYWORDS Secondary Glaucoma, Lens Induced Glaucoma, Phacomorphic Glaucoma, Uveitic Glaucoma

Scleral fixation of hydrophobic acrylic intraocular lenses using a suture burial technique.

The procedure involved an ab-externo scleral fixation technique using a double-armed 10-0 polypropylene suture with straight needles that require no scleral flaps. The IOLs are sutured to the sclera, the free suture ends are tied to the suture loops, and they are buried together under the sclera. Forty eyes of 37 patients were included. Postoperative complications are IOL capture in five eyes (12.5%), a significant IOL tilt in one eye (2.5%), recurrent UGH (uveitis-glaucoma-hyphema) syndrome in two eyes (5%), glaucoma in three eyes (7.5%), suture exposure in two eyes (5%) and IOL drop due to haptic breakage in one eye (2.5%). The technique can be effectively used for the refixation of dislocated hydrophobic acrylic IOLs by temporary haptic externalization through a corneal incision and for the treatment of aphakia with or without penetrating keratoplasty. Surgeons should be aware of the possibility of UGH syndrome due to IOL capture, especially in young eyes.

Uveitis–Glaucoma–Hyphema Syndrome: a Review and Exploration of New Concepts

Uveitis–glaucoma–hyphema (UGH) syndrome is a rare but serious complication of cataract extraction and other anterior segment procedures. If left untreated, UGH syndrome can lead to permanent vision loss and visual disability. The purpose of this review is to discuss the etiology, pathogenesis, and presenting signs and symptoms of UGH syndrome. Additionally, we will review the clinical and diagnostic tools used to aid in confirming the diagnosis of UGH syndrome and discuss both the standard and newly developed management strategies for this condition. While the current management of UGH syndrome still involves lens extraction, new surgical techniques designed to preserve the intraocular lens (IOL) have been reported. Additionally, options for IOL reimplantation are discussed. The best treatment for a specific case of UGH syndrome depends on the exact underlying cause of the condition, and as such is variable. We present a variety of recent studies describing novel treatment methods and diagnostic techniques, as well as IOL exchange techniques.

Intraocular Lens Complications: Decentration, Uveitis–Glaucoma–Hyphema Syndrome, Opacification, and Refractive Surprises

As cataract surgery has evolved, intraocular lens (IOL) complications are rare. The purpose of this review was to report the incidence, diagnosis, and management of IOL decentrations, uveitis-glaucoma-hyphema (UGH) syndrome, IOL opacifications, and refractive surprises. Literature review was performed by searching PubMed, MEDLINE, EMBASE, and the Cochrane Controlled Trial Database and the reference lists of original studies as well as reviews. Intraocular lens decentrations and dislocations can appear at any time, particularly in patients with predisposing factors such as pseudoexfoliation, prior vitreoretinal surgery, or trauma. Recognizing when they require surgical intervention for UGH or to improve visual function is critical in limiting long-term sequela. Intraocular lens opacifications such as glistenings rarely require intervention, but others, such as subsurface nanoglistenings, calcifications, or discolorations, may require IOL exchange. Finally, despite our best efforts to enhance measurements and IOL calculations, refractive surprises still occur. Intraocular lens complications are uncommon with modern cataract surgery. A number of these complications require proper identification and care to optimize patient outcomes.

Surgical management of uveitis-glaucoma-hyphema syndrome.

To report outcomes of patients after intraocular lens (IOL) repositioning or exchange for the version of the uveitis-glaucoma-hyphema (UGH) syndrome that does not include closed loop anterior chamber IOL (nUGH). Chart review of patients with nUGH who underwent IOL repositioning or exchange by one surgeon were reviewed. The main outcome measures were best corrected visual acuity (BCVA) as a decimal fraction preoperatively and postoperatively after IOL repositioning or exchange. Clinical findings evaluated included the presence of uveitis, hyphema, elevated intraocular pressure (IOP), and other complications such as pigment dispersion or vitreous hemorrhage. The number of anti-inflammatory and glaucoma medications were assessed before and after IOL repositioning or exchange. The study included 14 pseudophakic eyes. The median time at the onset of contemporary UGH after cataract extraction and IOL implantation (CE/IOL) was 7.5y. IOL repositioning or exchange was performed at a mean duration of 8.1±4.7mo (median: 4mo) after onset of UGH. The mean BCVA was improved from 0.45±0.26 preoperatively after onset of UGH syndrome to 0.76±0.22 (P=0.016) after IOL repositioning or exchange. Among the 14 eyes, uveitis, elevated IOP, and hyphema were present preoperatively in 13, 13, and 6 eyes, respectively. Uveitis and hyphema resolved in all cases after IOL surgery. The mean IOP was reduced from 26.4±4.5 mm Hg preoperatively to 14.7±4.9 postoperatively (P=0.01). The mean number of glaucoma medications used was reduced from 1.7±1.1 medications preoperatively to 0.8±1.08 (P=0.04) postoperatively. IOL repositioning or exchange is an effective treatment in many cases for medically resistant contemporary UGH syndrome.

Outcomes of Using Sutureless, Scleral-Fixated Posterior Chamber Intraocular Lenses

ABSTRACTBackground. Implantation of sutureless, scleral-fixated posterior chamber intraocular lenses (SSFIOL) is a promising option in the surgical management of patients unable to undergo standard cataract surgery due to insufficient capsular support. The purpose of this study was to describe the indications, visual outcomes and complications of SSFIOL implantation.Methods. Retrospective, investigational cohort study of 112 consecutive SSFIOL implantations between July 2013 and August 2017. Pre-operative ocular morbidity, operative indications, postoperative outcomes, complications, and reinterventions were summarized. Visual and refractive outcomes were compared between the pre- and latest postoperative visit using Wilcoxon signed-ranked test.Results. Mean follow-up: 13.0 ± 10.4 months. Primary surgical indication was dislocated IOL due to zonular weakness (77 eyes (68.8%)). At latest follow-up, there was improvement in uncorrected visual acuity (1.3 ± 0.8 to 0.64 ± 0.60 logMAR, p < .01), best-corrected visual acuity (BCVA) (0.6 ± 0.5 logMAR to 0.36 ± 0.40 logMAR, p < .01). Postoperative complications included transient IOP elevation >30 mmHg (26.8%), cystoid macular edema (CME) (14.3%), transient hypotony (13.4%), iris capture (12.5%), uveitis-glaucoma-hyphema (UGH) syndrome (11.6%), vitreous hemorrhage (VH) (6.3%). Operative reinterventions included SSFIOL exchange (3.6%), SSFIOL repositioning (5.4%), SSFIOL removal (2.7%). Ten (8.9%) patients required multiple re-interventions.Conclusion. SSFIOL implantation is a reasonable option for eyes with inadequate capsular support, resulting in visual improvement in most patients. Many of the surgical complications were related to a floppy iris-lens diaphragm (UGH syndrome, iris capture), which were predisposed in eyes with complex pathology. Surgical modifications can be made to minimize the iris-related complications.

Late-onset uveitis-glaucoma-hyphema syndrome caused by Soemmering ring cataract

To propose a late-onset mechanism for uveitis-glaucoma-hyphema (UGH) syndrome caused by Soemmering ring cataract (SRC) and describe surgical outcomes. Retrospective interventional case series. Patients developing UGH from anterior displacement of a haptic from a SRC. A retrospective chart review was conducted of all patients referred to an anterior segment surgeon (J.C.H.) for intraocular lens (IOL) reposition/exchange between January 2003 and June 2017. Inclusion criteria consisted of all eyes with (i) a diagnosis of UGH syndrome, and (ii) SRC causing anterior displacement of a sulcus-fixated haptic with iris-haptic touch. Outcome measures were change in best corrected visual acuities (BCVA) and resolution of UGH findings. Seven eyes of 7 patients developed UGH secondary to a SRC causing contact between the IOL optic/haptic and the iris/uvea. Diagnosis of UGH was made at a mean 9.1 years after IOL implantation; this was statistically different compared with UGH eyes with other mechanisms from our full UGH cohort (mean 5.4 years; p = 0.0367). The mean preoperative LogMAR BCVA of 0.45 improved to 0.37 after surgical intervention (p = 0.27). Resolution (or nearly full resolution) of UGH findings was achieved in all cases after SRC extraction and lens repositioning/exchange. Late-onset UGH syndrome can be caused by SRC. Surgical removal of the SRC with IOL repositioning within the capsular bag resolves most if not all components of UGH. Anterior segment ultrasound biomicroscopy is a helpful modality for determining if a SRC is present by demonstrating anatomic relationships commonly obscured by a miotic pupil.

Laser iridotomy to treat uveitis-glaucoma-hyphema syndrome secondary to reverse pupillary block in sulcus-placed intraocular lenses: Case series

To present cases of uveitis-glaucoma-hyphema (UGH) syndrome due to reverse pupillary block in sulcus-placed posterior chamber intraocular lenses (PC IOLs) that were managed with laser peripheral iridotomy (LPI). Community-based subspecialty clinics. Retrospective interventional case series. A chart review of patients with a sulcus-placed PC IOLs presenting with UGH syndrome and reverse pupillary block with posterior iris bowing as diagnosed by gonioscopy and anterior segment optical coherence tomography was carried out. Laser peripheral iridotomy was performed in the eyes included in the study. The main outcome measure was clinical resolution of UGH syndrome. The study included 6 eyes of 6 patients with a mean age of 59.8 years (range 43.0 to 66.0 years) who presented with unilateral UGH syndrome a mean of 28.7 months (range 0.3 to 84.0 months) after PC IOL implantation. All patients were previously myopic, with 5 (83.3%) having a history of vitrectomy. The mean axial length was 27.0 mm ± 1.4 (SD). An LPI was used to treat the reverse pupillary block with resultant improvement in iris profile and resolution of UGH syndrome in all eyes. The mean intraocular pressure decreased from 30.5 ± 10.0 mm Hg on 0.5 ± 0.8 glaucoma medications to 15.5 ± 3.2 mm Hg postoperatively on 0.7 ± 1.2 medications. The UGH syndrome due to reverse pupillary block occurred after sulcus-placed PC IOLs in susceptible patients, those with axial myopia, and post-vitrectomized eyes. The cases were managed with LPIs. Dr. Ahmed is a consultant to Alcon Laboratories, Inc. and Abbott Medical Optics, Inc. No author has a financial or proprietary interest in any material or method mentioned.

Scleral fixation of intraocular lenses using Gore-Tex suture: clinical outcomes and safety profile

Background/aimsTo report the short-term safety profile and clinical outcomes of scleral fixation of intraocular lenses (IOLs) using Gore-Tex suture.MethodsRetrospective, interventional case series. 85 eyes of 84 patients undergoing ab externo...

Uveitis-glaucoma-hyphema syndrome associated with recurrent vitreous hemorrhage

Case reportA 61-year-old pseudophakic male with recurrent blurred vision episodes associated with uveitis, hyphema, glaucoma and vitreous hemorrhage. Iris transillumination defects and apposition of the optic and iris were found. The patient was diagnosed with uveitis-glaucoma-hyphema (UGH) syndrome. DiscussionMechanical irritation of the iris is a consequence of intraocular lens malposition and causes UGH syndrome. Occasionally it is associated with vitreous hemorrhage. Lens malposition is detected by optical coherence tomography and/or ultrasound biomicroscopy.