Spontaneous bilateral anterior partial in-the-bag intraocular lens dislocation following routine annual eye examination

Bilateral posterior capsule rupture and anterior vitreous prolapse from vigorous eye rubbing

Purpose

We present the case of a 71-year-old male who developed decreased visual acuity eleven years after uncomplicated bilateral cataract extraction and in-the-bag IOL implantation following recent bouts of vigorous eye rubbing.

Observations

On examination, the posterior capsules were ruptured centrally in both eyes, and there was anterior vitreous prolapse bilaterally. While both IOLs remained in the visual axis, there was mild bilateral decentration and resultant decreased vision.

Conclusion and importance

To the authors’ knowledge, this is the first reported case of bilateral simultaneous posterior capsule rupture with anterior vitreous prolapse due to eye rubbing. Contrasting to previous case reports, this scenario demonstrates that severe eye rubbing can have variable severity and complications. Frequent and vigorous eye rubbing can be a precipitating cause of late postoperative posterior capsule rupture and should be avoided in pseudophakic patients, especially those with older IOL models.

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

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.

Late spontaneous bilateral intraocular lens subluxation accompanied with intraocular pressure elevation in a patient with acromegaly

A 53-year-old male with newly diagnosed acromegaly came to our clinic with the chief complaint of diplopia. He had the past ocular history of uneventful phacoemulsification cataract surgery with intraocular lens (IOL) implantation in the right eye 17 years ago and left eye 15 years ago. Postoperative examination showed remarkable improvement in visual acuity. Two years ago, he developed elevated intraocular pressure (IOP) in both eyes, which was well-controlled with the use of travoprost 0.004%/timolol 0.5%. At the clinic, slit-lamp examination revealed inferiorly subluxated IOL bilaterally. The patient received IOL repositioning with pars plana vitrectomy and scleral fixation in the left eye smoothly. We hypothesize that excess growth hormone is associated with dysregulation of fibrillin, resulting in zonular weakness, which causes late bilateral IOL subluxation. Elevated IOP may also be related to acromegaly. To the best of our knowledge, this is the first report to describe the association between IOL subluxation and acromegaly.

[Characteristics and management of Uveitis-Glaucoma-Hyphema syndrome]

INTRODUCTION

Uveitis-Glaucoma-Hyphema syndrome (UGH) is caused by mechanical chafing of anterior segment structures by an intraocular lens, especially an anterior chamber lens. The objective of this study was to characterise the clinical course and risk factors of UGH syndrome at a time when posterior chamber implantation is the gold standard.

PATIENTS AND METHODS

This was a retrospective study of 30 cases of UGH syndrome managed between January 2014 and September 2018. Data from the initial clinical examination, the type of implant involved and the clinical management were analysed.

RESULTS

Thirty eyes of 28 patients were included. Intra ocular lenses were iris-sutured (15/30, 50 %), in the bag (6/30, 20 %), scleral-fixated (4/30, 13.3 %), in the ciliary sulcus (3/30,10 %) or "in and out" (2/30, 6.7 %). Initial management was medical (18 eyes) or surgical (12 eyes). Surgical procedures were explantation (n=4), IOL repositioning (n=7) or trabeculectomy (n=1). Recurrences occurred with medical treatment (9/18), but not in the surgical group (p=0.02). Ocular hypertension became chronic in 19 cases out of 30 (63.3 %).

CONCLUSION

UGH syndrome can be caused by any type of pseudophakic lens. An intraocular lens in the bag should not rule out the diagnosis. Despite the decreasing popularity of anterior chamber intraocular lens implantation, UGH syndrome remains a current condition and must be recognised in order to adapt therapeutic management.

A novel application of B-ultrasonography at various head positions in the diagnosis of untypical uveitis-glaucoma-hyphema (UGH) syndrome: A case report

RATIONALE

Uveitis-glaucoma-hyphema (UGH) syndrome could be identified by conventional ultrasound biomicroscopy (UBM) and B-ultrasonography, but failed in some untypical cases. We introduced a novel application of B-ultrasonography in diagnosis of UGH syndrome in a rare case.

PATIENT CONCERNS

A 60-year-old woman was referred for distending pain with blurred vision for more than 1 month in the right eye after cataract surgery.

DIAGNOSES

B-ultrasound scanner and UBM demonstrated the Intraocular Lens (IOL) was centered in the bag. No chafing in all directions was detected between IOL and iris/ciliary body. The proposed diagnoses were iridocyclitis and secondary glaucoma of the right eye.

INTERVENTIONS

The symptoms were not improved after antiinflammation and intraocular pressure (IOP) lowering treatment for 1 month. B-ultrasonography was applied in horizontal, sitting, and head-down positions. The results demonstrated movements of IOLs when position changed. The IOLs were in contact with the iris pigment epithelium in sitting position and head-down positions but not in horizontal position. The dynamic interactions between IOLs and iris/ciliary body implied a diagnosis of UGH syndrome. The IOLs were then extracted.

OUTCOMES

Two weeks after the IOLs explantation, the IOP significantly reduced to a normal level in both eyes. Ten-month follow-up showed that the IOP was maintained at a normal level.

LESSONS

The chronically intermittent chafing between IOL and iris in specific head positions would also lead to UGH syndrome. Dynamic application of B-ultrasonography in various head positions could be useful in the diagnosis of an untypical UGH syndrome.

A Rare Manifestation of Uveitis-glaucoma-hyphema Syndrome

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.

How to cite this article: Sousa DC, Leal I, Faria MY, Pinto LA. A Rare Manifestation of Uveitis-glaucoma-hyphema Syndrome. J Curr Glaucoma Pract 2016;10(2):76-78.

Bilateral spontaneous anterior dislocation of intraocular lens with the capsular bag in a patient with pseudoexfoliation

We report a rare case of bilateral spontaneous anterior partial in-the-bag intraocular lens (IOL) dislocation in a 75-year-old man with pseudoexfoliation (PXF). He underwent uneventful phacoemulsification in both eyes with in-the-bag IOL implantation 9 years back. In the right eye, single piece poly (methyl methacrylate) (PMMA) IOL (+19 D) and in the left eye, single piece acrylic foldable IOL (+19 D) were implanted. An attempt at pharmacological IOL repositioning was unsuccessful. The dislocated IOLs were explanted and exchanged with scleral suture fixated PMMA IOLs. Vision improved to 20/30 in both eyes following surgery, without any associated ocular morbidity. We believe that zonular weakness secondary to PXF, capsular contraction, and myopia together were the predisposing factors for partial anterior dislocation of IOLs and IOL exchange with scleral suture fixation of IOL is a safe and effective treatment option.