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    UGH rare, but potentially devastating complication

    New Orleans—Patients who have uveitis-glaucoma-hyphema (UGH) syndrome caused by the complications after implantation of an anterior chamber IOL fared worse with final visual outcomes than patients who also develop UGH but have other lenses implanted, said Albert Cheung, MD.

    Speaking at ASCRS 2016, Dr. Cheung said UGH is a complication of intraocular chafing from IOL implants that can lead to a host of defects characterized by chronic inflammation, cystoid macular edema, secondary iris neovascularization, recurrent hyphema, and glaucomatous optic neuropathy.

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    This mechanical iris trauma can develop immediately after cataract surgery or can develop over the course of years. Reports in the literature note UGH was first discovered as a result of excessive lens movement, and poorly manufactured lens edges may have been an initial primary cause, as might iris-clipped IOLs or rigid closed-loop haptics.

    This complication was first reported in anterior chamber IOLs, but has also been reported in one-piece and three-piece posterior chamberIOLs, iris-supported IOLs, and in-the-bag dislocated IOLs.

    Surgery is commonly the only treatment to repair the damage done. Although a severe complication of cataract surgery, it is also fairly rare. But that also means it is often difficult to diagnose.

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    In this 10-year (2005-2015) retrospective chart review, Dr. Cheung analyzed 249 patients who had been referred for evaluation for IOL reposition or exchange. Of those initial 249 patients, 56 eyes (53 patients) were determined to have UGH at presentation. All eyes underwent repositioning or exchange by a single surgeon.

    Eyes were then sorted into groups based on IOL type and IOL position. Outcomes of one-piece, three-piece, and anterior chamber IOLs were then compared for initial/final visual acuity, time from initial cataract surgery to diagnosis of UGH, number of physicians seen prior to the UGH diagnosis, and development of glaucoma, uveitis/cystoid macular edema, transillumination defects (TIDs), and hyphema/vitreous hemorrhage.

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    “In these cases, we were defining UGH to include evidence of a malpositioned optic or haptic either on examination or by ultrasound biomicroscopy,” Dr. Cheung said.

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