Recurrent Vitreous Hemorrhage Secondary to Sulcus Positioning of a One-Piece Acrylic Intraocular Lens Haptic: Report of 3 Cases and Management With Retrocapsular Haptic Repositioning

Abstract

Three pseudophakic patients presented with recurrent, unilateral vitreous hemorrhage, one of which also had uveitis, glaucoma, and hyphema, consistent with “uveitis–glaucoma–hyphema (UGH)-Plus” syndrome. Arcuate transillumination defects secondary to inadvertent placement of 1 intraocular lens (IOL) haptic in the sulcus were identified in each case. The second haptic and optic were located in the capsular bag. The IOLs were all single-piece foldable acrylic lenses with square-edge haptic design. Surgical repositioning of the malpositioned haptic from the sulcus to the retrocapsular space resulted in the resolution of the recurrent vitreous hemorrhage. This series highlights the fact that recurrent vitreous hemorrhage secondary to iris chafing, with or without UGH, may occur in cases where a square-edge IOL haptic is placed in the sulcus. Vitrectomy with repositioning of the malpositioned IOL is a simple alternative to IOL exchange in these cases.

Keywords

UGH hyphema transillumination defects glaucoma IOL repositioning uveitis haptic

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References

Chang

Masket

Miller

. Complications of sulcus placement of single-piece acrylic intraocular lenses: recommendations for backup IOL implantation following posterior capsule rupture. J Cataract Refract Surg. 2009;35(8):1445–1458. doi:10.1016/j.jcrs.2009.04.027.

Choyce

. Complications of the AC implants of the early 1950’s and the UGH or Ellingson syndrome of the late 1970’s. J Am Intra Ocul Implant Soc. 1978;4(2):22–29.

Percival

Das

. UGH syndrome after posterior chamber lens implantation. J Am Intra Ocul Implant Soc. 1983;9(2):200–201.

Piette

Canlas

OAQ

Tran

Ishikawa

Liebmann

Ritch

. Ultrasound biomicroscopy in uveitis-glaucoma-hyphema syndrome. Am J Ophthalmol. 2002;133(6):839–841.

Badakere

Senthil

Turaga

Garg

. Uveitis-glaucoma-hyphaema syndrome with in-the-bag placement of intraocular lens. BMJ Case Rep. 2016;2016. doi:10.1136/bcr-2015-213745.

Zhang

Hood

Vrabec

Cullen

Parrish

Moroi

. Mechanisms for in-the-bag uveitis-glaucoma-hyphema syndrome. J Cataract Refract Surg. 2014;40(3):490–492. doi:10.1016/j.jcrs.2013.12.002.

LeBoyer

Werner

Snyder

Mamalis

Riemann

Augsberger

. Acute haptic-induced ciliary sulcus irritation associated with single-piece AcrySof intraocular lenses. J Cataract Refract Surg. 2005;31(7):1421–1427. doi:10.1016/j.jcrs.2004.12.056.

Masket

. Pseudophakic posterior iris chafing syndrome. J Cataract Refract Surg. 1986;12(3):252–256.

Alfaro-Juárez

Vital-Berral

Sánchez-Vicente

Alfaro-Juárez

Muñoz-Morales

. Uveitis-glaucoma-hyphema syndrome associated with recurrent vitreous hemorrhage. Arch Soc Espanola Oftalmol. 2015;90(8):392–394. doi:10.1016/j.oftal.2014.11.007.

10.

Sousa

Leal

Faria

Pinto

. A rare manifestation of uveitis-glaucoma-hyphema syndrome. J Curr Glaucoma Pract. 2016;10(2):76–78. doi:10.5005/jp-journals-10008-1205.

11.

Aonuma

Matsushita

Nakajima

Watase

Tsushima

Watanabe

. Uveitis-glaucoma-hyphema syndrome after posterior chamber intraocular lens implantation. Jpn J Ophthalmol. 1997;41(2):98–100.

12.

Gualtieri

Rossini

Forlini

. Vitrectomy and translocation of the anterior chamber intraocular lens to the sulcus: a closed microsurgical technique for the UGH syndrome. Ophthalmic Surg Lasers Imaging. 2008;39(4):325–327.

13.

Emanuel

Randleman

Masket

. Scleral fixation of a one-piece toric intraocular lens. J Refract Surg. 2013;29(2):140–142. doi:10.3928/1081597X-20130117-10.