Uveitis-Glaucoma-Hyphema Syndrome Following iStent Implantation

Abstract

Minimally invasive glaucoma surgery (MIGS) is a subset of glaucoma surgery that is known for its low rate of complications both intraoperatively and postoperatively compared to traditional filtering surgery. We present a case of a patient who, after receiving uncomplicated cataract extraction with posterior chamber intraocular lens implantation and concurrent iStent trabecular bypass stent implantation, experienced recurrent episodes of spontaneous microhyphema and inflammation in the late postoperative period. The patient, who had a history of mild asymmetric exfoliative glaucoma but no identifiable sources of trauma, underwent extensive examination to investigate causes of his episodic anterior segment bleeding and mild inflammation with concurrent elevated intraocular pressure. Given the circumstances of the patient’s recurrent symptoms and a negative workup for conventional causes of recurrent hyphema, it was suspected that the patient’s iStent was interacting with the patient’s peripheral iris, causing microtrauma and hyphema. We hypothesized that this contact was potentially exacerbated by pre-existing exfoliation syndrome, which caused zonular weakness and subsequent anterior movement of the lens-iris diaphragm. After the patient’s third recurrence of microhyphema and inflammation, the patient underwent removal of iStent and concurrent OMNI canaloplasty for glaucoma. Six months post-iStent explantation, the patient has had complete resolution of symptoms without recurrence of hyphema. In this case report, we outline the course of this patient’s symptoms and diagnosis, discuss the potential of MIGS devices such as iStent to cause recurrent hyphema, and explore treatment options following removal.

Haptic Amputation Under Endoscopic Guidance in Uveitis-Glaucoma-Hyphema Syndrome: A Case Report

“…UGH syndrome or Ellingson syndrome was first coined by Ellingson in 1978 [ 1 ]. It is a rare postoperative complication in which the intraocular implants or devices, mainly IOLs (either anterior or posterior IOLs) or iris prostheses, produce chronic mechanical chaffing to the adjacent uveal tissues (iris and/or ciliary body) and/or TM resulting in a wide spectrum of clinical findings including elevated IOP [ 1 , 3 ]. It is less often seen with devices such as glaucoma implants (e.g.…”

“…Uveitis-glaucoma-hyphema (UGH) syndrome was first coined by Ellingson in 1978 and it is a rare postoperative complication in which the intraocular implants or devices with irregular placement or inappropriate design (e.g. intraocular lenses (IOLs)) produce chronic mechanical chaffing to the adjacent uveal tissues (iris or ciliary body) and/or trabecular meshwork (TM) resulting in a wide spectrum of clinical manifestations ranging from chronic uveitis to secondary pigment dispersion, iris transillumination defects (TIDs), hyphema, macular oedema, or spiked intraocular pressure (IOP) [1][2][3][4].…”

“…Direct damage to TM, hyphema, pigment dispersion, or recurrent inflammation all contribute to repeated elevated IOP attacks, which may result in glaucomatous optic neuropathy [ 3 , 4 ].…”

A Case of Uveitis-Glaucoma-Hyphema Syndrome Related to a Hydrus Microstent

“…They had an unrevealing workup including ultrasound biomicroscopy for the etiology of the recurrent symptoms. After removal of the iStent, the patient’s symptoms subsided and did not recur 7 . There is also a case of UGH syndrome related to implantation of an EX-PRESS miniature shunt (Alcon) 8 years after its placement 8 .…”

„Minimally invasive glaucoma surgery“ – Kammerwinkelbasierte Verfahren im Vergleich

“…Unmittelbar nach optimaler Implantation tre-ten häufig kleinere Refluxblutungen aus den Kollektorkanälchen aus den Ostien der Stents auf, die in der Regel innerhalb von ein paar Tagen selbstlimitierend sind. Kommt es selten Wochen bis Monate nach der Stentimplantation zu rezidivierenden Vorderkammerblutungen, kann ein Uveitis-Glaukom-Hyphäma-Syndrom die Ursache sein [20]. Vermutlich ausgelöst durch mechanische Irritationen, kommt es zu Reizzuständen, die durch die Entfernung der Stents beruhigt werden können.…”