Aims: To report a case of a patient who developed uveitis-glaucoma-hyphema (UGH) syndrome after an uneventful cataract surgery and to discuss risk factors, diagnostic challenges, management options, and clinical implications.
Background: Uveitis-glaucoma-hyphema syndrome is a rare but potentially serious cataract surgery complication. Clinical manifestations include increased intraocular pressure (IOP), anterior chamber inflammation, and recurrent hyphema or microhyphema. Uveitis-glaucoma-hyphema Plus syndrome also includes accompanying vitreous hemorrhage. Although classically associated with rigid anterior chamber intraocular lenses (lOLs), cases of malpositioning and subluxated posterior chamber lOLs have also been described as possible triggers.
Case description: We report a case of a 70-year-old Caucasian man who developed UGH Plus syndrome after an uneventful cataract surgery with an lOL implanted in the capsular bag. During postoperative follow-up, persistent intraocular inflammation, increased IOP, hyphema, and vitreous hemorrhage were consistent with this diagnosis. Slit-lamp examination demonstrated progressive localized iris atrophy, compatible with chafing of the posterior iris by the IOL haptic as the trigger for UGH syndrome. A pars plana vitrectomy was performed and a retropupillary intraocular lens was implanted. No further complications occurred during follow-up.
Conclusion and clinical significance: Given the increasing prevalence of single-piece lOLs implanted in the capsular bag, it is important to recognize UGH syndrome as a rare but potentially serious complication.
Mierlo CV, Pinto LA, Stalmans I. Surgical management of iatrogenic pigment dispersion glaucoma. J Curr Glaucoma Pract 2015 Jan-Apr;9(1):28-32.
Sharma A, Ibarra MS, Piltz-Seymour JR, Syed NA. An unusual case of uveitis-glaucoma-hyphema syndrome. Am J Ophthalmol. 2003 Apr;135(4):561-563.
Chang DF, Masket S, Miller KM, Braga-Mele R, Little BC, Mamalis N, Oetting TA, Packer M, ASCRS Cataract Clinical Committee. Complications of sulcus placement of singlepiece acrylic intraocular lenses: recommendations for backup IOL implantation following posterior capsule rupture. J Cataract Refract Surg 2009 Aug;35(8):1445-1458.
Boutboul S, Letaief I, Lalloum F, Puech M, Borderie V, Laroche L. Pigmentary glaucoma secondary to in-the-bag intraocular lens implantation. J Cataract Refract Surg 2008 Sep;34(9):1595-1597.
Foroozan R, Tabas JG, Moster ML. Recurrent microhyphema despite intracapsular fixation of a posterior chamber intraocular lens. J Cataract Refract Surg 2003 Aug;29(8):1632-1635.
Magargal LE, Goldberg RE, Uram M, Gonder JR, Brown GC. Recurrent microhyphema in the pseudophakic eye. Ophthalmology 1983 Oct;90(10):1231-1234.
Pueringer SL, Hodge DO, Erie JC. Risk of late intraocular lens dislocation after cataract surgery, 1980–2009: a populationbased study. Am J Ophthalmol 2011 Oct;152(4):618-623.
Ford JR, Werner L, Owen L, Vasavada SA, Crandall A. Spontaneous bilateral anterior partial in-the-bag intraocular lens dislocation following routine annual eye examination. J Cataract Refract Surg 2014 Sep;40(9):1561-1564.
Fernández-Buenaga R, Alio JL, Pérez-Ardoy AL, Larrosa- Quesada A, Pinilla-Cortés L, Barraquer R, Alio JL 2nd, Muñoz-Negrete FJ. Late in-the-bag intraocular lens dislocation requiring explanation: risk factors and outcomes. Eye (Lond). 2013 Jul;27(7):795-801; quiz 802.
Jakobsson G, Zetterberg M, Lundström M, Stenevi U, Grenmark R, Sundelin K. Late dislocation of in-the-bag and out-of-the bag intraocular lenses: ocular and surgical characteristics and time to lens repositioning. J Cataract Refract Surg 2010 Oct;36(10):1637-1644.
Piette S, Canlas OA, Tran HV, Ishikawa H, Liebmann JM, Ritch R. Ultrasound biomicroscopy in uveitis-glaucomahyphema syndrome. Am J Ophthalmol 2002 Jun;133(6):839-841.
Van Liefferinge T, Van Oye R, Kestelyn P. Uveitis-Glaucoma- Hyphema Syndrome: a Late Complication of Posterior Chamber Lenses. Bull Soc Belge Ophtalmol 1994;252:61-65; discussion 66.