UGH syndrome is the triad of uveitis, glaucoma, and hyphema which all can be induced as a complication from sulcus IOL placement. The uveitis tends to be low grade and chronic and the glaucoma may take months to develop. Similarly, the hyphema may not be obvious since it could be a micro-hyphema with just red cells floating in the aqueous. This patient has endured about two years of chronic inflammation and increased intra-ocular pressure. We need to help him.
The most common cause is the placement of a single-piece acrylic IOL in the sulcus, which should never be done.
Even a three-piece IOL can cause UGH syndrome if the edges of the IOL optic come in contact with the posterior surface of the iris. In the case of a piggyback 3-piece acrylic IOL, the optic is pushed anterior by the original IOL which is in the capsular bag. This case required explantation of both IOLs and the replacement with a single IOL.
In our case shown here, the patient has a three-piece acrylic IOL in the sulcus and it is tilted, allowing contact between the optic edge and the back surface of the iris. We take out this IOL, perform an anterior vitrectomy for prolapsed vitreous, and then insert a three-piece silicone IOL with rounded edges. This ensures that even if there is contact between the IOL optic and the iris, it is far more gentle than the hard, square edge of the acrylic IOL.
click below to learn how to fix UGH syndrome in this case: