Uveitis-Glaucoma-Hyphema Syndrome Following Implantable Collamer Lens Implantation

To report the recurrent episodes of spontaneous hyphema along with elevated intraocular pressure (IOP) after an implantable collamer lens (ICL) implantation.

A 32-year-old female underwent uneventful bilateral ICL implantation. Postoperative treatment consisted of topical instillation every 6 hours for a week of levofloxacin and loteprednol. Vision, IOP and vault height remained stable in 1 week and 1 month postoperative follow-up. The patient complained right eye vision impaired, and experienced recurrent episodes of spontaneous anterior segment bleeding and elevated IOP in 3 and 4 months respectively after surgery. The patient had a history of wiping right eye before her first hyphema and heavy weight lifting before her second hyphema but no identifiable sources of trauma. Hemorrhage, behind the superior iris, accumulated around the pupil and paralysis of superior iris were noticed in slit lamp examination. After symptomatic treatment for 1 week, her vision and IOP returned to normal. The patient refused ICL reposition and insisted on ICL removal. Lens removal for both eyes were performed 1 week after the second recurrence of hyphema, and no lens dislocation was detected during the surgery. Two weeks after the lens removal, ultrasound biomicroscopy (UBM) showed a iris-ciliary cyst, 0.3×0.4mm in size behind the superior iris, which did not appear before the ICL implantation. Two months follow-up after lens removal, the patient had no more recurrence of hyphema.

Given that the patient’s recurrent symptoms and UBM results, it was suspected that the patient’s ICL was interacting with her superiorly peripheral iris, causing microtrauma and hyphema. We hypothesized that this contact was potentially exacerbated by the iris-ciliary cyst, which started to grow behind the superior haptics after the ICL implantation. Uveitis-glaucoma-hyphema (UGH) syndrome is a rare ophthalmic postoperative complications in which the implant produces chronic mechanical chaffing to the adjacent uveal tissues, resulting in hyphema, spiked IOP, or chornic uveitis. Conventional treatment is to reposition or remove the implant. UGH should be noted after anterior segment surgery, and more effective treatment worth exploring.