Case Reports

Uveitis-Glaucoma-Hyphema (UGH) Syndrome

Case Report Details

First Author: F.Hermoso Fernandez SPAIN

Co Author(s):    M. Cruz Rojo   M. Gascón Ginel   J. García Serrano   R. Martínez Castillo   L. Mesones Ruiz   J. Muñoz de Escalona Rojas     

Abstract Details

Purpose:

To identify the underlying causes and signs of UGH Syndrome. Factors that have to be taken into consideration.

Setting:

Department of Ophthalmology of the San Cecilio University Hospital of Granada, Spain.

Report of Case:

A 63-year-old woman, pseudophakic of both eyes for 8 years, who went to the emergency room for recurrent episodes of blurred vision, floaters, redness, elevated intraocular pressure (IOP), vitreous hemorrhage and pain in the left eye during the last 3 years. The symptoms were alleviated by the systemic and topical administration of IOP-lowering and anti-inflammatory medications. She was being treated with isoniazid for a possible pan-uveitis caused by a mycobacterium tuberculosis. The puncture of aqueous humor was negative for herpes virus. Ophthalmologist exploration revealed: Visual acuity in his right eye was (OD)= 1 and (OS)=1 in his left eye. A slit-lamp examination revealed depigmentation and atrophy of the iris (possibly due to the touch of the lens haptic), tyndall test (+++), blood deposit in endothelium and conjunctival hyperemia of the left eye. Intra-ocular pressure(IOP) was 18 and 36 mmHg in right and left eye respectively. Fundoscopy examination showed a vitreous hemorrhage. The patient underwent intraocular lens (IOL) explantation surgery (the superior lens haptic was out of the capsule), capsule extraction and anterior vitrectomy. There was no lens implantation due to the high myopia of the patient (2D lens was necessary). After intervention, the best corrected visual acuity(BCVA) was (OD)= 1 ind (OS)=1. Slit-lamp examination exposed aphakia without inflammation signs. Intra-ocular pressure(IOP) was 18 and 18 mmHg in right and left eye respectively. An improvement of the symptomatology has been observed in recents check ups. No medication has been necessary until now.

Conclusion/Take Home Message:

To be aware of the mechanisms of uveitis-glaucoma-hyphema(UGH) syndrome: (Mechanical irritation caused by IOL malposition or subluxation provoking mechanical and repetitive trauma to the iris, IOL well positioned with proximity of the edge of the optic IOL edge to the lower pupillary margin pressing on the peripheral iris, or zonal laxity due to pseudoexfoliation caused by phacodonesis). - Previously rotated iris, plateau iris and fibrosis configuration capsule around the optics caused by contact at various points. - To identify postoperative signs (transillumination, microhyphemas, dispersion of pigment, neovascularization of the iris, macular cystoid edema, recurrent vitreous hemorrhage…) to make a diagnosis as soon as possible. - To consider that UGH syndrome can be caused by any type of pseudophakic lens and an intraocular lens in the bag should not rule out the diagnosis.

Financial Disclosure:

None