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A. Kuo, J. Yu, A. Eller, R. Noecker; UGH Syndrome Associated With the Acrysof SA60 at Intraocular Lens Following Placement Within the Capsular Bag . Invest. Ophthalmol. Vis. Sci. 2006;47(13):616.
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The uveitis–glaucoma–hyphema (UGH) syndrome is caused by direct mechanical trauma to the iris from an intraocular lens (IOL). The popular one–piece acrylic AcrySof® SA60AT IOL (Alcon Surgical; Fort Worth, TX) is intended for intracapsular placement following cataract extraction. If implanted within the ciliary sulcus, it can cause pigmentary dispersion glaucoma due to characteristics of its design. Our purpose is to report the development of UGH syndrome in patients following uncomplicated intracapsular implantation of the SA60AT during cataract surgery.
This retrospective case series from two university tertiary referral clinics presents four patients with UGH syndrome following uneventful phacoemulsification with intracapsular implantation of the SA60AT IOL as described in the operative reports. The patients were seen and managed by the authors.
All four patients presented with anterior chamber inflammation and hyphema, and three of the four had associated elevation of intraocular pressure at presentation. All had transillumination defects and asymmetric heavier pigmentation of angle structures within the affected eye on gonioscopy. None had an identifiable primary vascular, retinal, or antecedent traumatic cause for their hyphema. Ultrasound biomicroscopy of all patients showed optic and/or haptic dislocation out of the capsular bag and into the sulcus causing IOL to iris contact. This was confirmed surgically in the two patients who underwent IOL exchange. The other two were able to be managed medically.
Four patients are presented with UGH syndrome following uneventful intracapsular implantation of the SA60AT IOL. This IOL can be traumatic to the iris if placed within the ciliary sulcus due to its thickness, zero–angulation, and "sharp" square edged haptics; hence the manufacturer warns against its use in the sulcus. However, even with intended intracapsular placement, a large or irregular capsulorrhexis that fails to contain the IOL may play a role in the subluxation of these IOLs from the capsular bag into the sulcus and result in the rare complication seen in these cases.
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