Uveitis–Glaucoma–Hyphema Syndrome Following Sulcus Placement of a Single-Piece Intraocular Lens: A Case Report
Indranil Saha *
Regional Institute of Ophthalmology, Eye Hospital Sitapur, Sitapur – 261001, Uttar Pradesh, India.
Nidhi Singh
Regional Institute of Ophthalmology, Eye Hospital Sitapur, Sitapur – 261001, Uttar Pradesh, India.
Madhvee Mishra
Regional Institute of Ophthalmology, Eye Hospital Sitapur, Sitapur – 261001, Uttar Pradesh, India.
*Author to whom correspondence should be addressed.
Abstract
Background: Uveitis–glaucoma–hyphema (UGH) syndrome is a mechanical complication resulting from chronic iris irritation by a malpositioned intraocular lens (IOL). Although classically associated with anterior chamber IOLs, UGH syndrome is increasingly reported following misaligned sulcus placement of single-piece acrylic IOLs, which are designed for capsular bag fixation.
Aim: To report a case of UGH syndrome caused by improper sulcus placement of a single-piece acrylic IOL and to emphasise the importance of early diagnosis and timely surgical management.
Methods: This case report describes a 41-year-old man who presented with recurrent ocular pain, redness, and decreased vision one year after phacoemulsification complicated by posterior capsular rupture and followed by pars plana vitrectomy. Examination included best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp biomicroscopy, gonioscopy, and anterior segment optical coherence tomography (AS-OCT).
Results: At presentation, BCVA was 6/36 and IOP was 36 mmHg. Slit-lamp examination revealed anterior chamber cells and flare, pigment dispersion, and iris chafing. Gonioscopy showed broad-based peripheral anterior synechiae exceeding 270° with dense trabecular meshwork pigmentation. AS-OCT confirmed sulcus malposition of the single-piece acrylic IOL with haptic–iris contact. Initial medical therapy (topical corticosteroids and antiglaucoma agents) failed to control inflammation or IOP. The patient underwent IOL explantation with secondary IOL implantation. Postoperatively, anterior chamber inflammation resolved completely and IOP stabilised at 14 mmHg without additional medications.
Conclusions: Sulcus placement of single-piece acrylic IOLs may cause UGH syndrome due to chronic haptic–iris contact. Early recognition by gonioscopy and AS-OCT, followed by prompt surgical removal or exchange of the offending IOL, is essential to prevent irreversible glaucomatous optic neuropathy.
Keywords: Uveitis-glaucoma-hyphema syndrome, single-piece intraocular lens, sulcus placement, anterior segment optical coherence tomography, pigment dispersion, secondary glaucoma