Abstract
Purpose :
To examine cases of new onset uveitis-glaucoma-hyphema (UGH) syndrome after posterior chamber intraocular lens (PCIOL) repositioning with iris-sutured IOL, differentiating between in-the-bag versus out-of-the-bag dislocations.
Methods :
Retrospective chart review was performed on 99 patients with a posteriorly dislocated IOL operated upon by a single surgeon from 2018-2020. Patients with previously diagnosed UGH, retained lens fragment, early dislocation, or lost-to-follow-up after one month were excluded. Variables of interest included 1-piece versus 3-piece IOL, in-the-bag versus out-of-the bag dislocation, and history of pxeudoexfoliation. UGH was defined as having at least one of the following: elevated intraocular pressure >25 mmHg, anterior uveitis, hyphema, or post-operative cystoid macular edema (CME).
Results :
24 patients were eligible for the study. 18 patients were noted to have in-the-bag dislocations (75%). A total of 12 patients developed UGH (50%). Two of the 12 patients (16.67%) exhibited uveitis, glaucoma, and CME. No patients had hyphema. Among patients with UGH, mean age was 73 years old. 7 of 12 cases were in-the-bag dislocations (58.3%), and 6 of 12 cases (50%) had pre-existing pxeudoexfoliation (PXE). Among in-the-bag dislocations with UGH, 5 out of 7 patients had 1-piece IOLs (71%); whereas among the 5 cases of out-of-the-bag dislocations with UGH, all had 3-piece IOLs. Moreover, none of the patients with out-of-the-bag dislocation had pre-existing PXE. A final logMAR VA of 0.314 for in-the-bag dislocations with UGH (p = 0.832) was not found to be statistically significant compared to out-of-the bag UGH patients. Mean follow-up time was 4.5 months. Patients were treated with topical steroids(9 out of 12, 75% ), topical nonsteroidal anti-inflammatory (8 out of 12, 67%), and pressure lowering drops (9 out of 12, 75%).
Conclusions :
UGH is a notable complication of iris sutured PCIOL repositioning. Pre-existing PXE may be a predisposing factor for in-the-bag dislocations. There was a tendency toward UGH with single-piece in-the-bag dislocations, and three-piece out-of-the-bag dislocations. Moreover, both in-the-bag and out of-the-bag dislocations appear to have similar visual outcomes. However, a larger sample size with longer follow-up time is necessary to draw more definitive conclusions.
This is a 2021 ARVO Annual Meeting abstract.