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Kandarakis SA, Petrou P, Katsimpris A, Mitsopoulou D, Chatziralli IP, Kanakis M, Halkiadakis I, Georgalas I. UGH Syndrome Resolution after IOL Explantation and Concomitant Carlevale IOL Implantation. Ocul Immunol Inflamm 2024; 32:320-325. [PMID: 36749924 DOI: 10.1080/09273948.2023.2169716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/02/2023] [Accepted: 01/12/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To examine the use of Carlevale IOL placement in patients with UGH, and to evaluate surgical outcomes. DESIGN In this retrospective study, 28 patients with UGH syndrome that were subjected to IOL explantation and concomitant Carlevale IOL implantation were included in the study. METHODS Information about VA, IOP, number of glaucoma medication, need for glaucoma surgery, presence of hemorrhage and inflammation were recorded up to 6 months after the procedure. RESULTS We found a statistically significant increase in mean visual acuity and complete resolution of uveitis in all patients. Mean IOP and the mean number of glaucoma medications were significantly decreased postoperatively, while 14% of patients required additional glaucoma surgery. CONCLUSIONS IOL explantation and concomitant Carlevale IOL implantation may provide a viable solution for UGH syndrome resolution, increases visual acuity, and decreases the need for glaucoma medication.
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Affiliation(s)
- Stylianos A Kandarakis
- First Ophthalmology Department, "G.gennimatas" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Petrou
- First Ophthalmology Department, "G.gennimatas" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Katsimpris
- First Ophthalmology Department, "G.gennimatas" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Mitsopoulou
- First Ophthalmology Department, "G.gennimatas" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Irini P Chatziralli
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Menelaos Kanakis
- Department of Ophthalmology, University of Patras, Patras, Greece
| | | | - Ilias Georgalas
- First Ophthalmology Department, "G.gennimatas" Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Alshehri M, Al Beshri A, Bamefleh D. Haptic Amputation Under Endoscopic Guidance in Uveitis-Glaucoma-Hyphema Syndrome: A Case Report. Cureus 2023; 15:e36303. [PMID: 37073188 PMCID: PMC10106119 DOI: 10.7759/cureus.36303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 03/19/2023] Open
Abstract
Uveitis-glaucoma-hyphema (UGH) syndrome is a rare ophthalmic postoperative complication in which the intraocular implants or devices like intraocular lenses (IOLs) produce chronic mechanical chaffing to the adjacent uveal tissues and/or trabecular meshwork (TM) resulting in a wide spectrum of clinical ophthalmic manifestations ranging from chronic uveitis to secondary pigment dispersion, iris defects, hyphema, macular oedema, or spiked intraocular pressure (IOP). Spiked IOP is a result of direct damage to the TM, hyphema, pigment dispersion, or recurrent intraocular inflammation. UGH syndrome generally develops over a time course, varying from weeks to several years postoperatively. Conservative treatment with anti-inflammatory and ocular hypotensive agents might be sufficient in mild to moderate UGH cases but surgical intervention with implant repositioning, exchange, or explantation might be necessary in more advanced situations. Here, we report our challenge in managing a one-eyed 79-year-old male patient with UGH secondary to migrated haptic, which was successfully managed by intraoperative IOL haptic amputation under endoscopic guidance.
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Vaiciuliene R, Rylskyte N, Baguzyte G, Jasinskas V. Risk factors for fluctuations in corneal endothelial cell density (Review). Exp Ther Med 2022; 23:129. [PMID: 34970352 PMCID: PMC8713183 DOI: 10.3892/etm.2021.11052] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/29/2021] [Indexed: 12/17/2022] Open
Abstract
The cornea is a transparent, avascular and abundantly innervated tissue through which light rays are transmitted to the retina. The innermost layer of the cornea, also known as the endothelium, consists of a single layer of polygonal endothelial cells that serve an important role in preserving corneal transparency and hydration. The average corneal endothelial cell density (ECD) is the highest at birth (~3,000 cells/mm2), which then decrease to ~2,500 cells/mm2 at adulthood. These endothelial cells have limited regenerative potential and the minimum (critical) ECD required to maintain the pumping function of the endothelium is 400-500 cells/mm2. ECD < the critical value can result in decreased corneal transparency, development of corneal edema and reduced visual acuity. The condition of the corneal endothelium can be influenced by a number of factors, including systemic diseases, such as diabetes or atherosclerosis, eye diseases, such as uveitis or dry eye disease (DED) and therapeutic ophthalmological interventions. The aim of the present article is to review the impact of the most common systemic disorders (pseudoexfoliation syndrome, diabetes mellitus, cardiovascular disease), eye diseases (DED, uveitis, glaucoma, intraocular lens dislocation) and widely performed ophthalmic interventions (cataract surgery, intraocular pressure-lowering surgeries) on corneal ECD.
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Affiliation(s)
- Renata Vaiciuliene
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania
| | - Neda Rylskyte
- Faculty of Medicine, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
| | - Gabija Baguzyte
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania
| | - Vytautas Jasinskas
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania
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Park JH, Ensor W, Olson J, Hale B. Intracapsular hemorrhage in the setting of pseudoexfoliation syndrome. Digit J Ophthalmol 2021; 26:4-6. [PMID: 33867875 DOI: 10.5693/djo.02.2020.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report the case of an 84-year-old man who presented with decreased vision in his left eye. Ocular history included bilateral pseudoexfoliative glaucoma and vitelliform macular dystrophy. He had undergone intraocular lens placement in both eyes 6 years before presenting at our institution. Over follow-up of 4 years, he experienced recurrent spontaneous hyphema and continued residual intracapsular hemorrhage. He was eventually diagnosed with uveitis-glaucoma-hyphema syndrome in the setting of pseudoexfoliation.
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Affiliation(s)
- Jean H Park
- Department of Ophthalmology, Geisinger Medical Center, Danville, Pennsylvania
| | - William Ensor
- Department of Ophthalmology, Geisinger Medical Center, Danville, Pennsylvania
| | - Joanna Olson
- Department of Ophthalmology, Geisinger Medical Center, Danville, Pennsylvania
| | - Benjamin Hale
- Department of Ophthalmology, Geisinger Medical Center, Danville, Pennsylvania
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Accorinti M, Saturno MC, Paroli MP, De Geronimo D, Gilardi M. Uveitis-Glaucoma-Hyphema Syndrome: Clinical Features and Differential Diagnosis. Ocul Immunol Inflamm 2021; 30:1408-1413. [PMID: 33793379 DOI: 10.1080/09273948.2021.1881563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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.
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Affiliation(s)
- Massimo Accorinti
- Department of Sense Organs, Sapienza University of Rome, Uveitis Center - AOU Policlinico Umberto I, Rome, Italy
| | - Maria Carmela Saturno
- Department of Sense Organs, Sapienza University of Rome, Uveitis Center - AOU Policlinico Umberto I, Rome, Italy
| | - Maria Pia Paroli
- Department of Sense Organs, Sapienza University of Rome, Uveitis Center - AOU Policlinico Umberto I, Rome, Italy
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Vaiciuliene R, Jasinskas V. Corneal endothelial status in different grades of late spontaneous in-the-bag IOL dislocation. Int Ophthalmol 2021; 41:1625-1634. [PMID: 33606154 DOI: 10.1007/s10792-021-01702-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 01/08/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate corneal endothelial cell density (ECD) in the eyes with different grades of late spontaneous in-the-bag intraocular lens (IOL) dislocation. METHODS A prospective study included seventy-eight patients who applied for IOL dislocation. Overall 80 eyes were divided into four grades based on the in-the-bag IOL dislocation classification. All eyes underwent a complete ophthalmological examination. ECD was evaluated using in vivo corneal confocal microscopy. RESULTS Median corneal ECD was 1929 (1022-2958) cells/mm2 of all the patients. The lowest number of ECD was in grade 2 (grade 1 median ECD 1990.33 (1182-2425.33) cells/mm2, grade 2-1577.0 (1022-2958) cells/mm2, grade 3-2205.84 (1259-2807.67) cells/mm2 and grade 4-2072.17 (1045-2581.0) cells/mm2). A statistically significant difference was observed between the median of ECD of grade 2nd and 3rd (p = 0.023). By grouping cases into those with and without glaucoma, we found that corneal ECD was significantly lower in eyes with glaucoma compared with eyes without glaucoma in grades 3 and 4 (p < 0.05), while in other grades, the difference did not reach the significance level. We divided the corneal ECD of all eyes into two categories ≤ 1500 cells/mm2 and > 1500 cells/mm2. Logistic regression demonstrated that the odds of having corneal ECD less than 1500 cells/mm2 increased by 3.5-fold if patients with IOL dislocation had been diagnosed with glaucoma previously. CONCLUSION Late spontaneous in-the-bag IOL dislocation reduced corneal ECD. Previously diagnosed glaucoma was the most common comorbidity. This condition has a significant impact on corneal ECD for patients with IOL dislocation.
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Affiliation(s)
- Renata Vaiciuliene
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu st. 2, LT-50161, Kaunas, Lithuania.
| | - Vytautas Jasinskas
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu st. 2, LT-50161, Kaunas, Lithuania
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Armonaite L, Behndig A. Seventy-one cases of uveitis-glaucoma-hyphaema syndrome. Acta Ophthalmol 2021; 99:69-74. [PMID: 32511897 DOI: 10.1111/aos.14477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess Uveitis-Glaucoma-Hyphaema syndrome (UGH syndrome) with focus on resolution, glaucoma development and risk factors. METHODS This retrospective case-control study with a cross-sectional component was performed to compare three groups with 71 patients each: UGH syndrome, dislocated intraocular lens (IOL) without UGH syndrome and ordinary pseudophakia. Main outcome measures were resolution of the UGH syndrome, best-corrected visual acuity (BCVA) and the need of glaucoma therapy. We also assessed the IOL-iris contact signs and the use of blood thinners. RESULTS Uveitis-Glaucoma-Hyphaema (UGH) syndrome resolved in 77 % of patients who underwent various kind of IOL surgery. Intraocular pressure (IOP) decreased and BCVA improved in the operated cases (p = 0.02 and p < 0.001, respectively), but not in the cases treated conservatively. Intraocular pressure (IOP) ≥22 mmHg at the first haemorrhage predicted the need of glaucoma therapy after UGH syndrome resolution (p = 0.002, area under the curve = 0.8). Fifty-one per cent of patients without preexisting glaucoma needed glaucoma therapy after UGH syndrome resolution. Pseudophacodonesis was seen more frequently in the UGH group than in the ordinary pseudophakia group (p = 0.001). Iris defects were not more frequent in the UGH group than in the Dislocated group but the types of defects differed (p < 0.0001). Blood thinners were not more frequent in UGH. CONCLUSION In UGH syndrome, the results are better with surgical intervention than with conservative treatment, but surgery does not guarantee resolution. Pseudophacodonesis is a risk factor for UGH syndrome, but blood thinners are not, and iris defects are not specific to UGH syndrome. A high IOP at the first haemorrhage increases the risk for needing subsequent IOP-lowering therapy.
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Affiliation(s)
- Laura Armonaite
- Department of Clinical Neuroscience Division of Ophthalmology and Vision St. Erik Eye HospitalKarolinska Institutet Stockholm Sweden
| | - Anders Behndig
- Department of Clinical Sciences/Ophthalmology Umeå University Hospital Umeå Sweden
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Garza PS, Man X, Queen JH, Ayres BM, McClendon T, Parrish EA, Reed DM, Moroi SE. Size Matters for Interplicata Diameter: A Case-Control Study of Plateau Iris. Ophthalmol Glaucoma 2020; 3:475-480. [PMID: 32771455 DOI: 10.1016/j.ogla.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/19/2020] [Accepted: 06/24/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Ultrasound biomicroscopy (UBM) has been used to characterize anterior segment dimensions in plateau iris configuration (PIC), but transverse measurements between the recesses of the ciliary sulcus (sulcus-to-sulcus diameter [STSD]) and the ciliary body processes (interplicata diameter [IPD]) have not been reported. We measured STSD and IPD and compared these among eyes with PIC, primary angle closure (PAC), and control eyes with open angles. DESIGN Retrospective, cross-sectional clinical study. PARTICIPANTS Sixty-nine participants, 37 PIC, 13 PAC, and 19 controls. METHODS We searched our clinical UBM database for PAC and PIC cases. Controls were assembled by reviewing images obtained for surveillance of ocular surface lesions. Anterior segment measurements were performed using the UBM digital caliper tool. Robust-fit ANOVA identified among-group differences. Pairwise t tests were used to test the significance of between-group differences. MAIN OUTCOME MEASURES Anterior chamber depth (ACD), angle opening distance (AOD), ciliary body area and thickness, iris area, horizontal and vertical STSD, and horizontal and vertical IPD. RESULTS Fifty-five left eyes were analyzed (30 PIC, 10 PAC, and 15 controls). ACD was smaller in PAC than in PIC and control eyes (P < 0.05 for PIC vs. PAC; P < 0.01 for control vs. PAC). Mean AOD was smaller in PIC than controls (P < 0.05) and smaller in PAC than PIC (P < 0.001). Vertical STSD was smaller in both PAC and PIC than controls (P = 0.04 for PIC vs. control; P < 0.01 for PAC vs. control). Horizontal STSD was smaller in PIC than controls (P = 0.02). Vertical IPD was smaller in PIC than controls (P = 0.04) and smaller in PAC than PIC eyes (P = 0.02). Horizontal IPD was smaller in PIC and PAC than controls (P = 0.03 for PIC vs. control; P < 0.01 for PAC vs. control). CONCLUSIONS STSD and IPD are narrower in PIC and PAC than in healthy eyes. Further studies that examine the ratio of white-to-white cornea diameter to the IPD may provide a mechanism for reported cases of in-the-bag uveitis-glaucoma-hyphema syndrome in PIC.
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Affiliation(s)
- Philip S Garza
- W. K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Xiaofei Man
- W. K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Department of Ophthalmology, Xin Hua Hospital, affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Joanna H Queen
- W. K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Department of Ophthalmology, Houston Methodist Hospital, Houston, Texas
| | - Bernadete M Ayres
- W. K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Tanya McClendon
- W. K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Elizabeth A Parrish
- W. K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - David M Reed
- Department of Ophthalmology & Visual Science, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sayoko E Moroi
- W. K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Department of Ophthalmology & Visual Science, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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Ragab IT, Abdelkader AME, Kishk HM, Elshal AA. Assessment of Post-Operative Pseudophakic Glaucoma by Ultrasound Biomicroscopy. Clin Ophthalmol 2020; 14:1495-1501. [PMID: 32581506 PMCID: PMC7276325 DOI: 10.2147/opth.s255626] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/19/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose Pseudophakic glaucoma is a secondary glaucoma in which intra-ocular pressure is elevated following cataract removal. The current study aimed to evaluate the role of ultrasound biomicroscopy (UBM) in assessing post-operative pseudophakic glaucoma. Patients and Methods This is a case series, prospective, observational and analytical study. It included 29 eyes of 29 patients with post-operative pseudophakic glaucoma. The patients were evaluated by medical history, detailed ophthalmologic examination and UBM. Results UBM examination has unmasked different causes of pseudophakic glaucoma. The detected causes were classified into 3 main groups, including intraocular lens (IOL)-related causes, lens remnants and intra-ocular inflammation. Haptic-related causes were present in 9 eyes, while 6 eyes had decentered or tilted IOLs. Soemmering's ring was the main cause in 3 eyes while in one eye the cause was lens particle in the anterior chamber (AC). Silicone oil in AC with seclusio pupillae was the main cause in one eye. Peripheral anterior synechiae were detected in 8 eyes while, posterior synechiae were evident in 7 eyes. Uveitis induced by anterior chamber IOL (ACIOL) was found in 3 eyes and one eye had peripheral anterior synechiae due to neovascular glaucoma. Conclusion UBM is a helpful diagnostic tool to evaluate causes of pseudophakic glaucoma through adequate visualization of different angle structures.
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Affiliation(s)
- Islam Taher Ragab
- Ophthalmology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Hanem Mohammad Kishk
- Ophthalmology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Liu Z, Zhang F, Wen Y, Du X, Pan X, Bi H. Diode laser transscleral cyclophotocoagulation for uveitis-glaucoma-hyphema syndrome: A case report. Medicine (Baltimore) 2020; 99:e18637. [PMID: 32049779 PMCID: PMC7035089 DOI: 10.1097/md.0000000000018637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 11/04/2019] [Accepted: 12/04/2019] [Indexed: 11/26/2022] Open
Abstract
RATIONALE To report a case of diode laser transscleral cyclophotocoagulation (DLTSC) for uveitis-glaucoma-hyphema syndrome (UGH). PATIENT CONCERNS The patient developed UGH on the right eye (OD) after vitrectomy and intraocular lens (IOL) implantation. DIAGNOSES Best corrected visual acuity (BCVA) was HM/50 cm, intraocular pressure (IOP) was 51.3 mm Hg on the OD. He was found to have 3+ anterior chamber cells. A B-scan ultrasound showed vitreous opacity. Ultrasound biomicroscopy (UBM) showed the chafing between the IOL and the posterior surface of the iris. Thus, he was diagnosed as UGH on the OD. INTERVENTIONS The patient was worried about the complications for removal of the IOL, a DLTSC approach was performed. OUTCOMES BCVA was 20/40 on the OD, IOP was 12 mm Hg on the OD. There were no anterior chamber inflammation and no vitreous opacity. UBM showed there was no contact between IOL and the posterior surface of the iris, the fundus of the eye was clearly visible. LESSONS UGH syndrome is a severe complication of cataract extraction. IOL extraction has been the traditional approach to treatment. DLTSC can be an option when the IOL is slightly tilted.
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Affiliation(s)
- Zhengfeng Liu
- Medical School of Ophthalmology & Optometry, Shandong University of Traditional Chinese Medicine
| | - Feng Zhang
- Shandong Provincial Hospital Affiliated to Shandong University
- Shandong Maternity & Child Health Care Hospital
| | - Ying Wen
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250002, China
| | - Xiujuan Du
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250002, China
| | - Xuemei Pan
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250002, China
| | - Hongsheng Bi
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250002, China
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Duchêne M, Iscar C, Muraine M, Gueudry J. [Characteristics and management of Uveitis-Glaucoma-Hyphema syndrome]. J Fr Ophtalmol 2020; 43:205-210. [PMID: 31982180 DOI: 10.1016/j.jfo.2019.07.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/25/2019] [Accepted: 07/27/2019] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- M Duchêne
- Service d'ophtalmologie-centre hospitalo-universitaire Charles-Nicolle, 22, boulevard Gambetta, 76031 Rouen, France
| | - C Iscar
- Service d'ophtalmologie-centre hospitalo-universitaire Charles-Nicolle, 22, boulevard Gambetta, 76031 Rouen, France
| | - M Muraine
- Service d'ophtalmologie-centre hospitalo-universitaire Charles-Nicolle, 22, boulevard Gambetta, 76031 Rouen, France
| | - J Gueudry
- Service d'ophtalmologie-centre hospitalo-universitaire Charles-Nicolle, 22, boulevard Gambetta, 76031 Rouen, France.
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Late-onset uveitis-glaucoma-hyphema syndrome caused by Soemmering ring cataract. Can J Ophthalmol 2019; 54:445-450. [DOI: 10.1016/j.jcjo.2018.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 09/10/2018] [Accepted: 09/14/2018] [Indexed: 11/23/2022]
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Wu N, Zhang H, Chen B, Ding W. A novel application of B-ultrasonography at various head positions in the diagnosis of untypical uveitis-glaucoma-hyphema (UGH) syndrome: A case report. Medicine (Baltimore) 2019; 98:e13891. [PMID: 30633162 PMCID: PMC6336659 DOI: 10.1097/md.0000000000013891] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
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.
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Jasinskas V, Vaiciuliene R, Varoniukaite A, Speckauskas M. Novel microsurgical management of uveitis-glaucoma-hyphema syndrome. Int Ophthalmol 2018; 39:1607-1612. [DOI: 10.1007/s10792-018-0972-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/16/2018] [Indexed: 10/28/2022]
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Hsing YE, Sharma A. The wandering intraocular lens: an unusual suspect. Clin Exp Optom 2017; 101:601-602. [PMID: 28726341 DOI: 10.1111/cxo.12568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/22/2017] [Accepted: 03/28/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Y Eve Hsing
- Caloundra Hospital, Caloundra, Queensland, Australia
| | - Anil Sharma
- Caloundra Hospital, Caloundra, Queensland, Australia.,Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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