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Uveitis–glaucoma–hyphema syndrome

April 06, 2024

Uveitis–glaucoma–hyphaema (UGH) syndrome, also known as Ellingson syndrome, is a complication of cataract surgery, caused by intraocular lens subluxation or dislocation. The chafing of mispositioned intraocular lens over iris, ciliary body or iridocorneal angle cause elevated intraocular pressure (IOP) anterior uveitis and hyphema. It is most commonly caused by anterior chamber IOLs and sulcus IOLs but, the condition can be seen with any type of IOL, including posterior chamber lenses and cosmetic iris implants.

Pathophysiology edit

The mechanical irritation of mispositioned intraocular lens over iris, ciliary body or iridocorneal angle cause spectrum of iris transillumination defects including anterior uveitis, hyphema and elevated intraocular pressure (IOP).[1][2] Uveitis results from mechanical breakdown of the blood–aqueous barrier and resultant intraocular inflammation. A hyphema results from damage to vascular tissue of the iris, ciliary body, or angle by mispositioned IOL. Elevated intraocular pressure can be caused by pigment dispersion, uveitis, hyphema or direct blocking of aqueous humor drainage system.[3]

UGH syndrome is most commonly caused by anterior chamber IOLs and sulcus IOLs, but it can be seen with any type of IOL, including posterior chamber lenses and cosmetic iris implants.[2][3] The condition has significantly reduced due to increased use of posterior chamber IOLs, advancements in lens design, IOL material and surgical techniques etc.[2] Currently, majority of IOLs are implanted in the capsular bag, minimizing the chance of IOL contacting uveal structures.[4]

Signs and symptoms edit

Uvietis, Glaucoma, and Hyphema are the classic sins of UGH syndrome, but the term is often used when one, two, or all three signs are present in the presence of any IOL causing mechanical irritation of the iris or angle structures.[3] Blurred vision, transient vision loss, eye pain, photophobia, erythropsia (objects appear red) are the main symptoms.[3]

Diagnosis edit

The diagnosis of UGH Syndrome is mainly based on patient history and eye examination. Patient will have history of cataract surgery with intraocular lens implantation. Slit-lamp examination may reveal hyphaema, aqueous cells and flare, iris neovascularization, mispositioned IOL, iris-lens contact, iris transillumination defects etc.[2]

Variations edit

UGH Plus and IPUGH (Incomplete Posterior UGH) are the variations of UGH syndrome. IPUGH is defined as bleeding into the posterior chamber with/ without glaucoma and no uveitis.[1] UGH Plus is defined as a UGH syndrome plus a vitreous hemorrhage and occurs more frequently with anterior chamber IOLs but can occur with any IOLs.[1]

Treatment edit

Initially, topical and systemic medication to control inflammation and raised IOP is appropriate, but the definitive treatment is an IOL reposition or exchange.[5] Topical corticosteroids may be used to control anterior inflammation.[2] Raised IOP can be lowered using topical and systemic anti-glaucoma medications such as prostaglandin analogs, beta-adrenergic antagonists, alpha-adrenergic agonists, and carbonic anhydrase inhibitors etc.[2]

History edit

The UGH Syndrome was originally described by Ellingson in 1978 and classically included uveitis, glaucoma, and hyphaema in the setting of an anterior chamber IOL.[3]

References edit

  1. ^ a b c Zemba, Mihail; Camburu, Georgiana (2017). "Uveitis–Glaucoma–Hyphaema Syndrome. General review". Romanian Journal of Ophthalmology. 61 (1): 11–17. doi:10.22336/rjo.2017.3. ISSN 2457-4325. PMC 5710046. PMID 29450365.
  2. ^ a b c d e f "Uveitis-Glaucoma-Hyphema Syndrome - EyeWiki". eyewiki.aao.org.
  3. ^ a b c d e Austin R, Fox; Jason P, Kam; Wallase L.M, Alward. "Uveitis Glaucoma Hyphema (UGH) Syndrome". EyeRounds.org.
  4. ^ Du, Yu; Zhu, Xiangjia; Yang, Jin; Zhang, Yinglei; Cai, Lei; Lu, Yi (10 January 2020). "Uveitis–glaucoma–hyphema syndrome with sclera-fixed posterior-chamber two-haptic intraocular lens in a highly myopic eye: a case report". BMC Ophthalmology. 20 (1): 22. doi:10.1186/s12886-020-1309-5. ISSN 1471-2415. PMC 6954629. PMID 31924181.
  5. ^ Johann, Ohly. "A Historical Perspective on UGH Syndrome". Glaucoma Today.

April 06, 2024
uveitis, glaucoma, hyphema, syndrome, uveitis, glaucoma, hyphaema, syndrome, also, known, ellingson, syndrome, complication, cataract, surgery, caused, intraocular, lens, subluxation, dislocation, chafing, mispositioned, intraocular, lens, over, iris, ciliary,. Uveitis glaucoma hyphaema UGH syndrome also known as Ellingson syndrome is a complication of cataract surgery caused by intraocular lens subluxation or dislocation The chafing of mispositioned intraocular lens over iris ciliary body or iridocorneal angle cause elevated intraocular pressure IOP anterior uveitis and hyphema It is most commonly caused by anterior chamber IOLs and sulcus IOLs but the condition can be seen with any type of IOL including posterior chamber lenses and cosmetic iris implants Contents 1 Pathophysiology 2 Signs and symptoms 3 Diagnosis 4 Variations 5 Treatment 6 History 7 ReferencesPathophysiology editThe mechanical irritation of mispositioned intraocular lens over iris ciliary body or iridocorneal angle cause spectrum of iris transillumination defects including anterior uveitis hyphema and elevated intraocular pressure IOP 1 2 Uveitis results from mechanical breakdown of the blood aqueous barrier and resultant intraocular inflammation A hyphema results from damage to vascular tissue of the iris ciliary body or angle by mispositioned IOL Elevated intraocular pressure can be caused by pigment dispersion uveitis hyphema or direct blocking of aqueous humor drainage system 3 UGH syndrome is most commonly caused by anterior chamber IOLs and sulcus IOLs but it can be seen with any type of IOL including posterior chamber lenses and cosmetic iris implants 2 3 The condition has significantly reduced due to increased use of posterior chamber IOLs advancements in lens design IOL material and surgical techniques etc 2 Currently majority of IOLs are implanted in the capsular bag minimizing the chance of IOL contacting uveal structures 4 Signs and symptoms editUvietis Glaucoma and Hyphema are the classic sins of UGH syndrome but the term is often used when one two or all three signs are present in the presence of any IOL causing mechanical irritation of the iris or angle structures 3 Blurred vision transient vision loss eye pain photophobia erythropsia objects appear red are the main symptoms 3 Diagnosis editThe diagnosis of UGH Syndrome is mainly based on patient history and eye examination Patient will have history of cataract surgery with intraocular lens implantation Slit lamp examination may reveal hyphaema aqueous cells and flare iris neovascularization mispositioned IOL iris lens contact iris transillumination defects etc 2 Variations editUGH Plus and IPUGH Incomplete Posterior UGH are the variations of UGH syndrome IPUGH is defined as bleeding into the posterior chamber with without glaucoma and no uveitis 1 UGH Plus is defined as a UGH syndrome plus a vitreous hemorrhage and occurs more frequently with anterior chamber IOLs but can occur with any IOLs 1 Treatment editInitially topical and systemic medication to control inflammation and raised IOP is appropriate but the definitive treatment is an IOL reposition or exchange 5 Topical corticosteroids may be used to control anterior inflammation 2 Raised IOP can be lowered using topical and systemic anti glaucoma medications such as prostaglandin analogs beta adrenergic antagonists alpha adrenergic agonists and carbonic anhydrase inhibitors etc 2 History editThe UGH Syndrome was originally described by Ellingson in 1978 and classically included uveitis glaucoma and hyphaema in the setting of an anterior chamber IOL 3 References edit a b c Zemba Mihail Camburu Georgiana 2017 Uveitis Glaucoma Hyphaema Syndrome General review Romanian Journal of Ophthalmology 61 1 11 17 doi 10 22336 rjo 2017 3 ISSN 2457 4325 PMC 5710046 PMID 29450365 a b c d e f Uveitis Glaucoma Hyphema Syndrome EyeWiki eyewiki aao org a b c d e Austin R Fox Jason P Kam Wallase L M Alward Uveitis Glaucoma Hyphema UGH Syndrome EyeRounds org Du Yu Zhu Xiangjia Yang Jin Zhang Yinglei Cai Lei Lu Yi 10 January 2020 Uveitis glaucoma hyphema syndrome with sclera fixed posterior chamber two haptic intraocular lens in a highly myopic eye a case report BMC Ophthalmology 20 1 22 doi 10 1186 s12886 020 1309 5 ISSN 1471 2415 PMC 6954629 PMID 31924181 Johann Ohly A Historical Perspective on UGH Syndrome Glaucoma Today Retrieved from https en wikipedia org w index php title Uveitis glaucoma hyphema syndrome amp oldid 1139742895, wikipedia, wiki, book, books, library,

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