Uveitis-glaucoma-hyphema Syndrome Research Articles

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.

Síndrome uveítis-glaucoma-hipema asociado a hemorragia vítrea de repetición

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.

Uveitis-Glaucoma-Hyphema (UGH) Syndrome - A Complex Complication

Uveitis-Glaucoma Hyphema syndrome is a condition involving cataract extraction complications. It is important to understand this rare complication of cataract extraction in order to preserve a patient’s vision. Misdiagnoses of UGH syndrome can cause excess testing and may eventually lead to loss of vision. This case report reviews the management of Patient 0 from the Illinois Eye Institute who suffered from UGH PLUS, details of his disease process along with clinical management employed throughout a 4-month span are described.

Intraocular lens explantation in Chinese patients: different patterns and different responses.

The aim of the study was to evaluate the indications and outcomes of intraocular lens (IOL) explantation in Chinese patients. The medical records of all Chinese patients who underwent IOL explantation in Hong Kong Eye Hospital, from January 2008 to March 2013, were reviewed. A total of 98 IOLs were explanted over the study period. The main reasons for lens removal included lens malposition (71.4%), isolated uveitis-glaucoma-hyphema (UGH) syndrome (9.1%), refractive surprise (6.1%), and pseudophakic bullous keratopathy (4.1%). "In-the-bag" IOL malposition was associated with intraocular complications during cataract extraction (28.9%) and high myopia (22.2%). Sulcus implantation of a single-piece acrylic (SPA) IOL resulted in UGH syndrome in all cases, while sulcus-fixated 3-piece lenses had such complication in only 7.1% of cases. Importantly, the problem persisted despite the removal of the SPA IOL from the ciliary sulcus. Majority of the patients had resolution of the original problems after lens removal or exchange and had the same or improved visual acuity after surgery. Lens malposition was the major indication of intraocular lens explantation in our case series. Resolution of symptoms and visual acuity can be achieved with IOL explantation. Implantation of SPA in ciliary sulcus is not recommended.

Anterior segment optical coherence tomography in the assessment of postoperative intraocular lens optic changes

To evaluate the use of anterior segment optical coherence tomography (AS-OCT) to assess postoperative intraocular lens (IOL) optic changes. John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Experimental study. Intraocular lenses explanted because of various complications were used, including poly(methyl methacrylate) (PMMA) IOLs with snowflake degeneration, hydrophilic acrylic IOLs with calcification, a silicone IOL with calcification from an eye with asteroid hyalosis, and hydrophobic acrylic IOLs explanted because of decentration, subluxation, or uveitis-glaucoma-hyphema syndrome. After gross and light microscopy, the IOLs were examined in the dry and hydrated states using AS-OCT. Selected hydrophilic acrylic IOLs were stained for calcium. In-the-bag IOLs in pseudophakic cadaver eyes were also evaluated by AS-OCT before and after explantation to confirm correspondence with the clinical situation. Intraoptic changes, such as snowflake lesions in PMMA IOLs, calcification in hydrophilic acrylic IOLs, and glistenings in hydrophobic acrylic IOLs, could be imaged by AS-OCT. The method was also helpful in analyzing the location and density. However, in cases of more superficial changes, unless the lesions/deposits were present on the optic surface with an extension to the optic substance of at least 0.1 mm, they could not be clearly differentiated from the overall outline of the IOL surface. Anterior segment OCT may be helpful in assessing the presence, location, and density of intraoptic changes, avoiding a misdiagnosis of IOL opacification and the performance of unnecessary procedures, such as posterior capsulotomy or vitrectomy.

Uveitis-Glaucoma-Hyphema Syndrome and Corneal Decompensation in Association With Cosmetic Iris Implants

To report a case and management of uveitis-glaucoma-hyphema (UGH) syndrome and corneal decompensation associated with cosmetic iris implants. Interventional case report. Department of Ophthalmology, University of Minnesota School of Medicine. A 29-year-old man presented with bilateral redness, severe pain, photophobia, and reduction in visual acuity. Examination revealed intraocular pressure (IOP) of 38 mm Hg and 40 mm Hg right and left eye respectively, bilateral conjunctival injection 3+, epithelial corneal edema, microhyphema, cells 3+ to 4+ and flare 2+, bilateral cosmetic iris implants, and surgical peripheral iridectomies. The patient was diagnosed with UGH syndrome and corneal decompensation associated with cosmetic iris implants. Immediate medical management of inflammation and elevated IOP, anterior segment imaging, specular microscopy, Humphrey 24-2 visual field (VF) testing; following failed conservative management, combined trabeculectomy and removal of the iris implants. Anterior chamber inflammation and microhyphema, IOP, and corneal edema. Anterior segment imaging demonstrated bilateral implant-iris apposition and implant-angle structures apposition. Specular microscopy demonstrated a significant reduction of the number of endothelial cells. VF test demonstrated a right superior arcuate scotoma and a normal left VF. Following surgical treatment IOP normalized and inflammation and microhyphema subsided. However, mild corneal edema persisted. Cosmetic iris implantation may lead to UGH syndrome and corneal decompensation. Therefore, its use should be reserved for patients with significant medical indications, and avoided in patients with intact natural iridies, until more short-term and long-term safety data are available.

Vitrectomy and Translocation of the Anterior Chamber Intraocular Lens to the Sulcus: A Closed Microsurgical Technique for the UGH Syndrome

This interventional case report presents an anterior chamber intraocular lens (AC-IOL) translocation technique to manage a case of uveitis-glaucoma-hyphema (UGH) syndrome associated with posterior dislocation of nuclear fragments and vitreitis as a consequence of capsule rupture during cataract surgery. Pars plana vitrectomy followed by an AC-IOL translocation from the anterior chamber to the sulcus without additional surgical corneal incision was performed. At 12 months' follow-up, the original AC-IOL was in stable position in the posterior chamber, with binocular refractive balance and no further astigmatism and resolution of the UGH syndrome.

Recurrent microhyphema despite intracapsular fixation of a posterior chamber intraocular lens

A 61-year-old woman experienced multiple episodes of transient visual blurring in her pseudophakic eye, each of which lasted about 1 hour. Repeat examination during a symptomatic episode revealed anterior chamber red blood cells consistent with a microhyphema in the pseudophakic eye despite intracapsular fixation of a posterior chamber intraocular lens (PC IOL). Ultrasound biomicroscopy confirmed intracapsular fixation of the IOL haptics and revealed proximity of the edge of the IOL optic to the inferior pupillary margin in the region of an iridociliary body cyst. Uveitis–glaucoma–hyphema syndrome may occur despite intracapsular fixation of a PC IOL.

An unusual case of uveitis-glaucoma-hyphema syndrome

Purpose To report a case of uveitis-glaucoma-hyphema (UGH) syndrome in which anterior chamber paracentesis led to the diagnosis of sickle cell trait. Design Observational case report. Methods A 43-year-old Cuban pseudophakic male was seen multiple times over a 3-year period complaining of floaters and blurry vision in his left eye. He was noted to have an inferotemporally displaced posterior chamber intraocular lens and recurrent microhyphemas with elevated intraocular pressure (IOP) readings between 29 and 46 mm Hg with each episode. He was diagnosed with UGH syndrome. Posterior chamber intraocular lens explantation and anterior chamber washout was performed. The aqueous fluid was submitted for cytopathologic examination. Results Postoperatively, the patient’s symptoms resolved and he had no further hemorrhages or elevated IOP readings. Cytopathology of the aspirate revealed sickled red blood cells. Conclusion Microscopic examination of aqueous fluid can be a valuable tool in diagnosing ophthalmic manifestations of systemic disease.

Indications for and results of intraocular lens explantation

We reviewed the medical records of 97 patients who had 101 consecutive intraocular lens (IOL) explantation procedures, with or without exchange, at the University of Florida Eye Center from January 1, 1983, to December 31, 1987. The majority of the removed IOLs were anterior chamber styles (53.9%), followed by iris-fixated lenses (33.7%). The most common indications for surgery included pseudophakic bullous keratopathy (PBK)—69%, uveitisglaucoma-hyphema (UGH) syndrome—9%, and 101, instability—7%. The best visual outcome was seen in patients with IOL instability; 50% achieved 20/40 or better visual acuity. Forty one percent of patients with PBK, who had IOL explantation/exchange combined with penetrating keratoplasty, achieved 20/40 or better visual acuity. The poorest visual outcome was seen in patients with the UGH syndrome; 83% had a final acuity of 20/200 or worse. However, these patients achieved resolution of their pain and inflammation and better control of their intraocular pressure as a result of the surgery. Complications leading to IOL explantation tended to occur months to years after the original surgery in patients with closed-loop, semi-flexible anterior chamber lenses and iris-fixated lenses. Posterior chamber lenses were most often removed because of complications unrelated to the implant.

Fox shield treatment of the UGH syndrome

The uveitis-glaucoma-hyphema (UGH) syndrome has been described with all types of intraocular lenses. The usual forms of therapy, include miotics, mydriatics, steroids, antiglaucomatons medications, laser therapy, and surgical explantation. I describe five patients in whom the UGH syndrome resolved after long-term Fox shield treatment to prevent nocturnal hand-eye trauma.

An analysis of semiflexible, closed-loop anterior chamber intraocular lenses

We present the pathologic and scanning electron microscopic findings from 44 semiflexible, all polymethylmethacrylate, anterior chamber intraocular lenses (IOLs). These IOLs, which have round, small diameter, closed loops were removed following a variety of complications, including uveitis and/or the uveitis-glaucomahyphema syndrome, secondary glaucoma, pseudophakic bullous keratopathy, cystoid macular edema, erosion into uveal tissue (with and without oval pupil), and iris neovascularization. Over 200,000 of these lens styles have been implanted. Even though the number of these IOLs accessioned in our laboratory is small, we feel this analysis documents some of the problems that may be encountered with this IOL design. Many of the complications documented in our series resulted in severe visual loss. In addition to tissue damage that appeared secondary to the mechanical tissue-to-implant interface, other causes of complications included variations in surgical technique, implantation into eyes with preexisting disease (including eyes that had undergone previous surgery), and damage to tissue that occurred during IOL removal.