Haptic Amputation Under Endoscopic Guidance In Uveitis- Glaucoma - Hyphema Syndrome

Conservative treatment might be sufficient in mild to moderate cases  of uveitis-glaucoma-hyphema (UGH) syndrome but surgical intervention might be necessary in more advanced situations. In cases of UGH induced by migrated haptic in the sulcus with no view of the implanted IOLs perioperatively, it can be managed safely and successfully by intraoperative IOL haptic amputation under endoscopic guidance which is a new safe way to salvage the intraocular lens (IOL) and help to control the disease.

The case presented to Emergency Room, and was admitted as in-patient for further workups and intervention at our institute; King Khaled Eye Specialist Hospital and Research Center (KKESH & RC) based in Riyadh, Saudi Arabia.

A 79-year-old male presented to the emergency department of our hospital with complaints of the right eye (seeing eye) mild to moderate ocular pain associated with a gradual decrease of vision over two years, which started getting worse in the last two months. On initial examination, his uncorrected visual acuity (VA) was hand motion (HM) in both eyes with no improvement with pinhole. The IOP measured with the Goldmann applanation tonometer (GAT) was 39 mmHg and 08 mmHg in his right and left eye, respectively. Upon investigating the patient we found that the IOL of the right eye was sublaxated. We decided to intervene surgically by cutting the haptic of the monofocal lens under endoscopic guidance. Patient did well post operatively, he regained a Visual Aquity of 20/70 with IOP of 11 mmgh with a fixed combination of antiglaucoma drops Simbrinza (brinzolamide 10 mg / 2 mgbrimonidine) twice daily applied, a month later.

The management of UGH syndrome involves a step ladder approach corresponding to the severity. Conservative treatment might be sufficient in mild to moderate cases but surgical intervention might be necessary in more advanced situations. In cases of UGH induced by migrated haptic in the sulcus with no view of the implanted IOLs perioperatively, it can be managed safely and successfully by intraoperative IOL haptic amputation under endoscopic guidance, that is a new techinque to help salvge the pre-existing IOL and help controling IOP by ceasing the bleeding source caused by continously sloughed iris tissue by the sublaxated IOL to reverse the pathology.