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Payal Shah, Katharine Dempsey, Hardik A Parikh, Mathew Karl, Joseph Tseng, Kenneth Wald; New Onset Uveitis-Glaucoma-Hyphema Syndrome after Iris Suturing for Posterior Chamber Intraocular Lens Dislocation. Invest. Ophthalmol. Vis. Sci. 2020;61(7):2072.
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© ARVO (1962-2015); The Authors (2016-present)
We primarily aim to determine the incidence of uveitis-glaucoma-hyphema (UGH) after surgical repair of late, in-the-bag posterior chamber intraocular lens (PCIOL) dislocations treated by PCIOL-capsular complex repositioning and iris-suture fixation technique. Secondarily, we aim to characterize the outcomes of patients with this complication.
We retrospectively reviewed the course of 212 patients with a lens repositioning surgical procedure by a single-surgeon in a four-year period, from 2014-2018. 68 patients with a posteriorly dislocated, in the capsular bag, PCIOL treated with iris-sutured lens repositioning with a follow-up duration of at least 3 months were included. Patients with pre-existing UGH, early dislocation within three months of cataracts extraction, or with retained lens material were excluded. UGH was defined as iritis or a combination of hyphema, high intraocular pressure, or vitreous hemorrhage.
After a median follow-up of 8.0 months, six (8.8% of 68) patients developed UGH at a median onset of 82.5 days from surgery. Baseline characteristics of these patients were the following: mean age of 70, initial intraocular pressure (IOP) of 18 ± 4, initial logarithm of the minimum angle of resolution visual acuity (logMAR VA) of 0.64 ± 0.56, and 1-piece IOL dislocation (83.3%). UGH was treated with topical corticosteroids in 5 patients (83.3%) and pressure lowering drops in 4 patients (66.7%). No patient required reoperation, nor had diminished vision. At a median follow-up of 8.0 months within this cohort with UGH, the final logMAR VA was 0.22 ± 0.06 (versus baseline, p=0.104), and the final IOP was 23 ± 10 (versus baseline, p=0.193).
UGH is a rare but notable complication of iris sutured PCIOL repositioning. Patients who develop UGH can be effectively treated with medical therapy without surgical intervention and achieve good final visual acuity outcomes. A syndrome combining signs of iritis, VH, hyphema, and sustained IOP elevation particularly with single piece PCIOLs should prompt consideration of a UGH diagnosis and early treatment intervention to optimize patient outcomes. Future prospective clinical trials are needed to compare overall complication rates and outcomes of in-the-bag lens repositioning surgery with scleral versus iris sutured fixation technique.
This is a 2020 ARVO Annual Meeting abstract.
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