Uveitis‐glaucoma‐ hyphema syndrome (UGH) as complication in the long‐term cataract surgery

Abstract

Purpose Although uveitis‐glaucoma‐hyphema (UGH) syndrome was described as a postoperative complication associated with intraocular lenses (IOL) in the anterior chamber, cases with IOL in the posterior chamber have also been described in both into capsular bag, in sulcus as well as lenses anchored to the iris. The physiopathology is not clear but it seems that the mechanical friction produced by the IOL haptics, in contact with different structures, produces erosion, pigment dispersion and consequently anterior uveitis accompanied by elevated intraocular pressure (IOP) and hyphema. Different treatments have been proposed: topical or systemic drugs, YAG laser iridectomies, capsular tension rings, anti‐VEGF or IOL explantion. Methods We present the case of a 40‐year‐old man who came to our emergency department with painful red left eye and blurred vision since several hours. He had a history of left congenital cataract surgery when he was 14. The patient presented uveitis with elevated IOP that did not yield with topical treatment with mydriatics, corticoids, antihypertensive drugs and oral diuretic agent. 24 hours later, he showed hyphema, deciding to enter the hospital IV for treatment. Symptomatic control was achieved, being discharged with topical treatment. 15 days later he returned to A&E at the same clinic. He was treated in the same way and ultrasonic biomicroscopy (UBM) was performed. Results UBM demostrated a poorly positioned IOL.Then, we diagnosed him with UGH syndrome. After presenting a third episode a week after discharge, explantation exchange was decided. Since then it is in follow‐up and has not submitted incidents. Conclusion The increase in cataract surgeries implies that a growth of the possible associated complications.UGH syndrome must be taken into account in all those patients who present their characteristic triad. Before suspicion a UBM should be performed.