Uveitis-Glaucoma-Hyphema Syndrome

☝️ iris transillumination defects

☝️ pigmentary dispersion

☝️ microhyphemas and hyphemas

☝️ elevated intraocular pressure (IOP).

✍️ most commonly caused by chaffing from anterior chamber intraocular lenses, but can occur from any type of pseudophakic lens ( even in bag IOL)

✍️ sulcus single piece acrylic IOL has been greatly accused and reported and tend to have a high UGH complication rate.

✍️ usually complicated with

☝️ chronic inflammation( iridocyclitis )

☝️ cystoid macular edema (CME)

☝️ secondary iris neovascularization

☝️ recurrent hyphemas

☝️ glaucomatous optic

☝️ eventually loss of vision.

✍️ Surgical intervention is often required as definitive treatment.

✍️ This syndrome is the result of mechanical irritation of anterior segment structures from an intraocular lens Or even cosmetic iris implants.

✍️ most commonly in elderly adults, but reported in the pediatric age group

✍️ within 6 months of IOL implant is consistently higher in anterior chamber lenses than in iris plane lenses than in posterior chamber lenses.

✅ Uveitis-Glaucoma-Hyphema Syndrome mechanism :

✍️ Hyphema can be due to

☝️ peripupillary contact of iris with lens optic and haptic

☝️ warpage of foot plates or edge imperfections leading to mechanical irritation

☝️ erosion of uveal structures including the iridocorneal angle, iris, and ciliary body.

☝️ breakdown of the blood-aqueous barrier and subsquent release of pigment, red blood cells, protein, and white blood cells into the anterior chamber.

✍️ high IOP

☝️ The release of protein and white blood cells. With pigment, red blood cells, and white blood cells in the anterior chamber

☝️ the trabecular meshwork can become blocked with an increase in intraocular pressure.

☝️ contact with angle structures by the IOL can cause destruction of outflow structures and increased IOP.

✅ Uveitis-Glaucoma-Hyphema Syndrome Diagnosis:

✍️ Symptoms

☝️ intermittent blurry vision

☝️ intermittent white-out of vision

☝️photophobia

☝️ redness

☝️ocular pain in the involved eye (may be out of proportion to ocular findings).

✍️ Signs

☝️ raised IOP

☝️ microhyphema or hyphema

☝️ anterior chamber cell and flare or hypopyon

☝️ iris neovascularization

☝️ iris-lens contact

☝️ iris transillumination defects

☝️ dislocated or malpositioned IOL

☝️ mal-positioned haptic

☝️ vitreous hemorrhage if the posterior capsule is not intact

☝️ CME.

☝️ the angle

• blood within

• increased pigmentation of the trabecular meshwork

• signs of mechanical erosion.

• abnormal haptic location

✅ Uveitis-Glaucoma-Hyphema Syndrome Diagnostic investigation:

✍️ Ultrasound biomicroscopy (UBM) is often used in the diagnosis of UGH syndrome

☝️ visualize malpositioned IOLs and their contact with uveal tissue and confirm the position of haptics and optics and their relationships to surrounding ocular structures.

✍️ OCT can help in diagnosing CME

✅ Uveitis-Glaucoma-Hyphema Syndrome Management:

✍️ Prevention

☝️ highly effective in decreasing incidence of the disease.

☝️ During routine cataract surgery a 1 piece lens and haptics should be placed within the lens capsule.

☝️ Single piece lens should never be placed in the sulcus.

☝️ a 3-piece lens should be placed within the sulcus.

☝️ reverse optic capture of the lens by placing the edges under the anterior capsulorhexis.

☝️ If there is inadequate capsular support then a 3 piece sulcus lens can be fixated via scleral fixation.

☝️ If an ACIOL is required then the correct size of lens should be chosen (horizontal corneal white-to-white distance plus 1mm).

✍️ Treatment

☝️ IOL repositioning

☝️ IOL explantation and exchange

☝️ Uveitis

• topical corticosteroids

☝️ ocular Hypertension

• IOP lowering topical and systemic medications such beta blockers or alpha agonists, and carbonic anhydrase inhibitors

• refractory cases treated surgically as glaucoma

☝️ Hyphema

• limited activity

• head elevation

• cycloplegics for ciliary spasm or photophobia

• topical corticosteroids for associated inflammation.