Occult cause of uveitis-glaucoma-hyphema syndrome diagnosed during treatment with endocyclophotocoagulation (ECP)

Amol A Sura; Amit K Reddy; Kelly Babic; Murtaza Saifee; Nisha R Acharya; John A Gonzales; Ying Han; Thuy A Doan

doi:10.1016/j.ajoc.2022.101537

Occult cause of uveitis-glaucoma-hyphema syndrome diagnosed during treatment with endocyclophotocoagulation (ECP)

Am J Ophthalmol Case Rep. 2022 Apr 12:26:101537. doi: 10.1016/j.ajoc.2022.101537. eCollection 2022 Jun.

Authors

Amol A Sura^{1

2}, Amit K Reddy^{1

2}, Kelly Babic², Murtaza Saifee², Nisha R Acharya^{1

2}, John A Gonzales^{1

2}, Ying Han², Thuy A Doan^{1

2}

Affiliations

¹ Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA.
² Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA.

Abstract

Purpose: To describe uveitis-glaucoma-hyphema (UGH) syndrome secondary to a posterior chamber intraocular lens (PCIOL) within the capsular bag in which pathogenic changes to the ciliary body were observed and treated with endocyclophotocoagulation (ECP).

Observations: An 85-year-old woman who had cataract surgery in her right eye four years ago presented with recurrent, unilateral, open-angle, hypertensive uveitis in her right eye. Her presentations were characterized by decreased vision, elevated intraocular pressure, corneal edema, a mixed anterior chamber reaction, and pigmented anterior vitreous cells. She had a frank vitreous hemorrhage during two episodes. Ultrasound biomicroscopy revealed a dense Soemmerring ring in her right eye without evidence of PCIOL-iris or PCIOL-ciliary body chafe. Subsequent ECP revealed whitened and atrophic ciliary processes adjacent to a tilted haptic within the capsular bag, consistent with chronic PCIOL-ciliary body chafe. ECP was applied to the affected ciliary processes, which successfully eliminated recurrences.

Conclusions and importance: UGH can rarely occur due to an PCIOL within the capsular bag. In cases where ultrasound biomicroscopy (UBM) does not show abnormalities and clinical suspicion remains high, ECP can be a useful adjunct to observe and treat abnormalities of the ciliary body.

Keywords: Endocyclophotocoagulation; Hypertensive uveitis; Hyphema; UGH; Uveitis; Vitreous hemorrhage.

Publication types

Case Reports