Int Ophthalmol (2019) 39:1607–1612 https://doi.org/10.1007/s10792-018-0972-5

CASE REPORT

Novel microsurgical management of -- hyphema syndrome

Vytautas Jasinskas . Renata Vaiciuliene . Aiste Varoniukaite . Martynas Speckauskas

Received: 15 February 2018 / Accepted: 16 June 2018 / Published online: 26 June 2018 Ó Springer Nature B.V. 2018

Abstract implantation few years ago and pseudophakodonesis Purpose To report a series of cases and microsurgi- caused by weakened zonules from pseudoexfoliation cal management of rarely occurring uveitis-glaucoma- with subsequent development of UGH syndrome. IOL hyphema (UGH) syndrome in patients with single- fixation to the with satisfactory postoperative piece acrylic intraocular (IOL) placed in the results was performed due to the development of capsular bag. UGH. Signs of syndrome did not recur 6 months after Methods It was a series of patients with UGH the operation. syndrome induced by posterior chamber IOL/capsular Conclusion UGH syndrome can be induced by bag complex instability (pseudophakodonesis), who unstable in-the-bag IOL due to zonular laxity. underwent IOL fixation to the iris. Visual acuity, Depending on the severity of the syndrome, this , number of glaucoma medications condition can be fought by applying a minimally and IOL status (position) were recorded by the same invasive approach—IOL suturing to the iris with protocol before and 6 months after the surgical direct observation under the surgical microscope treatment. precisely in the anticipated location with no or Results The case series presents three patients with minimal deformation. Symptoms of UGH did UGH syndrome caused by single-piece acrylic IOL not recur due to increased stability of the IOL and, as a placed in-the-bag. Each patient had uneventful pha- result of this, declined irritation of the uveal tissue. coemulsification with posterior chamber IOL Keywords Uveitis-glaucoma-hyphema syndrome Á Acrylic single-piece intraocular lens Á Pseudophakodonesis Intraocular lens fixation to the Poster: The XXXV Congress of the European Society of Á and Refractive Surgeons, October 2017, Lisbon, iris Portugal.

V. Jasinskas Á R. Vaiciuliene (&) Á M. Speckauskas Department of , Medical Academy, Lithuanian University of Health Sciences, Mickevicˇiaus g. Introduction 9, 44307 Kaunas, Lithuania e-mail: [email protected] Uveitis-glaucoma-hyphema (UGH) syndrome is a rare, but potentially severe cataract surgery compli- A. Varoniukaite Medical Academy, Lithuanian University of Health cation [1], first reported in 1978 by Ellingson and Sciences, Kaunas, Lithuania known as chafing of anterior segment structures— 123 1608 Int Ophthalmol (2019) 39:1607–1612 mechanical iris trauma—by first-generation anterior surgeon (V.J.) in 2017. Patients were examined by the chamber intraocular lenses (IOLs) [1, 2]. Although same protocol before and 6 months after the surgical UGH syndrome is classically associated with anterior treatment. Demographic information (age and gen- chamber IOL, reported cases of decentred or dislo- der), data of original cataract surgery, other previous cated posterior chamber IOL/capsular bag complex operations or laser procedures, ocular comorbidity, have also been described as possible triggers [1, 3]. visual acuity, intraocular pressure (IOP), number of The incidence of this syndrome has declined from a glaucoma medications and IOL status (position) were mean of 2.2–3 to 0.4–1.2% thanks to improved IOL recorded. design, surgical techniques and increased usage of posterior chamber IOL [4]. A more recent study revealed that