A single piece acrylic IOL does not work well in the sulcus because of its design: it is planar and the haptics are thick with relatively sharp edges. These characteristics can cause the posterior surface of the iris to become scraped leading to pigment loss, trans-illumination defects, and UGH syndrome. UGH stands for uveitis, glaucoma, and hyphema and these patients can exhibit some or all of these problems. Note that the hyphema is typically a micro-hyphema will red blood cells floating in the aqueous and not the standard layering hyphema with settled blood at the inferior angle. The solution is to perform an IOL exchange whereby the single-piece acrylic IOL is explanted and replaced with a three-piece IOL design which will work better with sulcus placement. This patient also received a visco-canaloplasty with the iTrack device. Great learning case for all of us.
