EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/276058
E W CATARACT 64 March 2014 by Scott Cole, MD, MS, Liliana Werner, MD, PhD, and Nick Mamalis, MD A case of uveitis-glaucoma-hyphema (UGH) syndrome following cataract surgery T he complication described in this article is well estab- lished, and it continues to be a detriment to patient outcomes. As single-piece hydrophobic acrylic intraocular lens (IOL) designs are becoming widely used worldwide, surgeons should be aware of the likelihood of this complication going forward. Case report Two years prior to presentation a 70- year-old woman had cataract surgery with placement of a posterior cham- ber IOL in the right eye. 1 Since sur- gery, she had bouts of blurred vision associated with combinations of anterior segment inflammation, an- terior chamber red blood cells, and mild vitreous hemorrhage. A few reactive iris vessels were seen, and a peripheral transillumination defect was detected (Figure 1). On consulta- tive examination, the acuity was 20/20 with an undesired myopic correction and the IOP was 15 mm H g. The anterior segment was quiet and notable for a well-centered SA60AT single-piece hydrophobic acrylic lens (Alcon, Fort Worth, Texas) with the optic in the capsular bag. However, ultrasound biomi- croscopy was performed, revealing that the temporal haptic of the lens was in front of the anterior capsule a nd in direct contact with the poste- rior iris surface (Figure 2). The tem- poral haptic extended though a wide capsulorhexis opening and was in contact with the peripheral iris, as seen through the transillumination defect overlying it. In view of the intermittent UGH syndrome, the patient elected to have an IOL exchange. This was performed uneventfully. At the six-month follow-up, the patient maintained 20/20 UCVA in the affected eye and the IOP with no medication was 13 mm Hg. The anterior segment remained without inflammation or evidence of hemorrhage. She reported no incidents of visual changes, ocular redness, or photo- phobia typical of her previous UGH syndrome episodes. Laboratorial analyses and results The specimen (explanted single- piece hydrophobic acrylic IOL) was submitted to our laboratory. Gross examination of the explanted IOL was performed, and gross photo- graphs were taken. The optic was bisected for explantation, and both haptics were intact. No adherent fi- brocellular material was seen on the optic or haptics. The lens was then evaluated and photographed under a light microscope. Under light mi- croscopy, the IOL showed the pres- ence of significant amounts of pigmented deposits on its anterior surface (Figure 3). 1 Comments The single-piece hydrophobic acrylic lens has square edges that have been shown to reduce the incidence of PCO. The single-piece lens incorpo- rates these square edges not only on the optic but along both haptics as well. When a single-piece lens is placed in the capsular bag, the square optic and haptic edges are covered by the anterior and poste- rior capsules, provided that the Cataract/IOL complications: Moran CPC reports Figure 1: Clinical photograph showing the temporal haptic of a single-piece hydrophobic acrylic IOL (arrows) in contact with the periphery of the iris, observed through a transillumination defect Figure 2: Ultrasound biomicroscopy demonstrating the haptic of the single-piece hydrophobic acrylic IOL (in cross section; arrows) apposed to and thinning the peripheral iris Figure 3: Light photomicrograph showing pigment dispersion on the surface of a single-piece hydrophobic acrylic IOL that was partially in the sulcus Source (all): Michael E. Snyder, MD Scott Cole, MD, MS Nick Mamalis, MD Liliana Werner, MD, PhD 64-75 Cataract_EW March 2014-DL2_Layout 1 3/6/14 3:09 PM Page 64