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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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Elhusseiny AM, Lee RK, Smiddy WE. Surgical management of uveitis-glaucoma-hyphema syndrome. Int J Ophthalmol 2020; 13:935-940. [PMID: 32566505 DOI: 10.18240/ijo.2020.06.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/18/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To report outcomes of patients after intraocular lens (IOL) repositioning or exchange for the version of the uveitis-glaucoma-hyphema (UGH) syndrome that does not include closed loop anterior chamber IOL (nUGH). METHODS Chart review of patients with nUGH who underwent IOL repositioning or exchange by one surgeon were reviewed. The main outcome measures were best corrected visual acuity (BCVA) as a decimal fraction preoperatively and postoperatively after IOL repositioning or exchange. Clinical findings evaluated included the presence of uveitis, hyphema, elevated intraocular pressure (IOP), and other complications such as pigment dispersion or vitreous hemorrhage. The number of anti-inflammatory and glaucoma medications were assessed before and after IOL repositioning or exchange. RESULTS The study included 14 pseudophakic eyes. The median time at the onset of contemporary UGH after cataract extraction and IOL implantation (CE/IOL) was 7.5y. IOL repositioning or exchange was performed at a mean duration of 8.1±4.7mo (median: 4mo) after onset of UGH. The mean BCVA was improved from 0.45±0.26 preoperatively after onset of UGH syndrome to 0.76±0.22 (P=0.016) after IOL repositioning or exchange. Among the 14 eyes, uveitis, elevated IOP, and hyphema were present preoperatively in 13, 13, and 6 eyes, respectively. Uveitis and hyphema resolved in all cases after IOL surgery. The mean IOP was reduced from 26.4±4.5 mm Hg preoperatively to 14.7±4.9 postoperatively (P=0.01). The mean number of glaucoma medications used was reduced from 1.7±1.1 medications preoperatively to 0.8±1.08 (P=0.04) postoperatively. CONCLUSION IOL repositioning or exchange is an effective treatment in many cases for medically resistant contemporary UGH syndrome.
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Affiliation(s)
- Abdelrahman M Elhusseiny
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA.,Department of Ophthalmology, Kasr Al-AinySchool of Medicine, Cairo University, Cairo 12611, Egypt
| | - Richard K Lee
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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Uveitis-glaucoma-hyphema syndrome with sclera-fixed posterior-chamber two-haptic intraocular lens in a highly myopic eye: a case report. BMC Ophthalmol 2020; 20:22. [PMID: 31924181 PMCID: PMC6954629 DOI: 10.1186/s12886-020-1309-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/03/2020] [Indexed: 11/19/2022] Open
Abstract
Background We report a case of uveitis–glaucoma–hyphema (UGH) syndrome in a highly myopic pseudophakic eye with seemingly normal positioning of a two-haptic intraocular lens (IOL). Case presentation The patient was a 61-year-old woman suffering recurrent episodes of blurred vision, floaters, redness, elevated intraocular pressure (IOP), and pain in the right eye following implantation of a sclera-fixed IOL. The symptoms were alleviated by the systemic and topical administration of IOP-lowering and anti-inflammatory medications. A slit-lamp examination revealed depigmentation and atrophy of the iris, and a quiet anterior chamber in the right eye. Endophthalmitis caused by hypovirulent bacteria and UGH syndrome were both considered. Ultrasound biomicroscopy (UBM) and gonioscopy provided direct evidence of malpositioned IOL haptics, which pushed the root of the iris forward, resulting in persistent mechanical chaffing, the probable cause of UGH syndrome. IOL explantation resolved her symptoms. Negative bacterial culture results for the IOL excluded the possibility of endophthalmitis. Conclusions Heightened awareness of underlying UGH syndrome and prompt UBM are important when doctors encounter a patient with a sclera-fixed IOL suffering from recurrent anterior segment inflammation and elevated IOP.
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Yang J, Qiu X, Cai L, Fan Q, Wang A, Zhang K, Lu Y. Uveitis-glaucoma-hyphema syndrome associated with an in-the-bag square-edge intraocular lens. PRECISION CLINICAL MEDICINE 2019; 2:283-287. [PMID: 35693875 PMCID: PMC8985814 DOI: 10.1093/pcmedi/pbz026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 11/25/2019] [Indexed: 11/16/2022] Open
Abstract
A 54-year-old woman presented with recurrent redness and blurred vision of the left eye with elevated intraocular pressure (IOP) for one year. She was treated as “iridocyclitis” and ``Posner-Schlossman syndrome'' at the local hospitals. However, the patient developed intermittent ocular inflammation and hyphema. Patient had a cataract surgery and intraocular lens (IOL) implantation in the left eye one year before at the local hospital. A diagnostic procedure was performed and the possible pathogenesis was discussed.
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Affiliation(s)
- Jin Yang
- Eye Institute, Eye & ENT Hospital of Fudan University, Shanghai 200031, China
- Key Laboratory of Myopia, Ministry of Health, Shanghai 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
| | - Xiaodi Qiu
- Eye Institute, Eye & ENT Hospital of Fudan University, Shanghai 200031, China
- Key Laboratory of Myopia, Ministry of Health, Shanghai 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
| | - Lei Cai
- Eye Institute, Eye & ENT Hospital of Fudan University, Shanghai 200031, China
- Key Laboratory of Myopia, Ministry of Health, Shanghai 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
| | - Qi Fan
- Eye Institute, Eye & ENT Hospital of Fudan University, Shanghai 200031, China
- Key Laboratory of Myopia, Ministry of Health, Shanghai 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
| | - Anjian Wang
- Eye Institute, Eye & ENT Hospital of Fudan University, Shanghai 200031, China
- Key Laboratory of Myopia, Ministry of Health, Shanghai 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
| | - Kang Zhang
- Macau University of Science and Technology, Macau 999078, China
| | - Yi Lu
- Eye Institute, Eye & ENT Hospital of Fudan University, Shanghai 200031, China
- Key Laboratory of Myopia, Ministry of Health, Shanghai 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
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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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Abstract
Uveitis-Glaucoma-Hyphaema Syndrome (UGH syndrome, or "Ellingson" Syndrome) is a rare condition caused by the mechanical trauma of an intraocular lens malpositioned over adjacent structures (iris, ciliary body, iridocorneal angle), leading to a spectrum of iris transillumination defects, microhyphaemas and pigmentary dispersion, concomitant with elevated intraocular pressure (IOP). UGH Syndrome can also be characterized by chronic inflammation, secondary iris neovascularization, cystoid macular edema (CME). The fundamental step in the pathogenesis of UGH syndrome appears to arise from repetitive mechanical iris trauma by a malpositioned or subluxed IOL. These patients have uncomplicated cataract implants and return for episodes of blurry vision weeks to months after surgery. This may be accompanied by pain, photophobia, erythropsia, anterior uveitis, hyphaema along with raised intraocular pressure. A careful history and examination, as well as appropriate investigations can confirm the diagnostic. Treatment options are IOL Explantation exchange, topical and systemic medication, and cyclophotocoagulation, the placement of a Capsular Tension Ring to redistribute zonular tension and Anti-vascular endothelial growth factor (anti-VEGF) Therapy.
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Affiliation(s)
- Mihail Zemba
- Ophthalmology Department, "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania
| | - Georgiana Camburu
- Ophthalmology Department, "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania
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Yang JM, Yoon KC, Ji YS. Transscleral fixation of single-piece foldable acrylic lens with eyelets at the optic-haptic junction. Can J Ophthalmol 2016; 50:367-72. [PMID: 26455972 DOI: 10.1016/j.jcjo.2015.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 06/06/2015] [Accepted: 07/24/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report the clinical outcomes of transscleral fixation using a single-piece foldable acrylic intraocular lens (IOL) with eyelets at the optic-haptic junction (enVista; Bausch & Lomb). DESIGN Retrospective, noncomparative case series. PARTICIPANTS Sixty eyes of 60 patients who underwent transscleral fixation with an enVista IOL were reviewed. METHODS Preoperative patient status, postoperative visual and refractive outcomes, and postoperative complications were analyzed. RESULTS The study included 60 eyes of 60 patients (52 males, 8 females) with a mean age of 56.65 ± 15.57 years. At final follow-up visit, the mean follow-up was 11.40 ± 4.24 months. The mean uncorrected visual acuity (logMAR) improved from 1.95 ± 0.90 to 0.85 ± 0.77 (p < 0.001), and best corrected visual acuity (logMAR) improved from 1.11 ± 1.13 to 0.64 ± 0.70 (p = 0.006). The mean spherical equivalent improved significantly from 6.90 ± 6.10 to 0.21 ± 2.10 D postoperatively (p < 0.001). Complications included transient ocular hypertension (15%), transient hypotony (7%), and hyphema (5%), but no serious complications were observed. In all cases, the IOL remained stable and well centred. CONCLUSIONS Transscleral fixation using a foldable acrylic IOL with eyelets at the optic-haptic junction can be a safe and effective alternative technique to manage cases with broken capsular bag or weak zonular support.
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Affiliation(s)
- Jee Myung Yang
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Kyung-Chul Yoon
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Yong-Sok Ji
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, South Korea.
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Angunawela R, Hugkulstone CE. Uveitis–glaucoma–hyphema syndrome and systemic anticoagulation. Eye (Lond) 2004; 19:226-7. [PMID: 15218519 DOI: 10.1038/sj.eye.6701443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Piette S, Canlas OAQ, Tran HV, Ishikawa H, Liebmann JM, Ritch R. Ultrasound biomicroscopy in uveitis-glaucoma-hyphema syndrome. Am J Ophthalmol 2002; 133:839-41. [PMID: 12036685 DOI: 10.1016/s0002-9394(02)01386-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess anterior segment anatomy in uveitis-glaucoma- hyphema syndrome. DESIGN Retrospective case series. METHODS Nine pseudophakic eyes (nine patients) with complete or incomplete uveitis-glaucoma-hyphema syndrome underwent ultrasound biomicroscopy. RESULTS Ultrasound biomicroscopy revealed intraocular lens malposition in each case. Of the eight eyes with posterior chamber intraocular lenses, haptics were in contact with the iris pigment epithelium (four eyes) or the pars plicata (three eyes) or prolapsed into the angle recess near a filtration bleb internal ostium (one eye). All other posterior chamber intraocular lens haptics were located in the ciliary sulcus with the exception of two in the capsular bag. Both haptics in the eye with the anterior chamber intraocular lens had eroded into the ciliary body. CONCLUSION By its ability to detect haptic position, ultrasound biomicroscopy can assist in elucidating the cause of uveitis-glaucoma-hyphema syndrome and in deciding on the course of treatment.
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Affiliation(s)
- Scott Piette
- Department of Ophthalmology, New York Eye and Ear Infirmary, New York, New York 10003, USA
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Tanner V, Rosen P, Skinner AR, McDonald B, Ferguson DJ. Electron microscopy study of explanted intraocular lenses from clinically noninfected eyes. J Cataract Refract Surg 1998; 24:1145-51. [PMID: 9719977 DOI: 10.1016/s0886-3350(98)80111-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To determine whether intraocular lenses (IOLs) in clinically noninfected eyes are coated with a significant, bacteria-containing biofilm. SETTING The Oxford Eye Hospital, Oxford, United Kingdom. METHODS Twenty-six IOLs, removed for reasons other than endophthalmitis from 26 patients attending the Oxford Eye Hospital over a 3 year period, were examined by electron microscopy. Immediately following explantation, the IOL was placed in glutaraldehyde 4% in 0.1 M phosphate buffer solution and processed for scanning electron microscopy (SEM). Areas of interest were reprocessed for transmission electron microscopy (TEM). RESULTS There was no evidence of a bacterial biofilm on any IOL. In 5 IOLs, significant host cellular debris was seen at the tip of the haptic or at the optic-haptic junction. In 4 of them, clusters of coccoid-shaped structures were seen at the optic-haptic junction on SEM, but examination by TEM showed these structures to be melanosomes, not bacteria. CONCLUSION We found no evidence to suggest that a significant number of IOLs are coated with a bacterial biofilm in clinically noninfected cases. We advocate the use of TEM to distinguish between coccoid bacteria and melanosomes.
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Affiliation(s)
- V Tanner
- Oxford Eye Hospital, Radcliffe Infirmary, United Kingdom
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