Ugh Syndrome And Iol Complications: A Conservative Yet Effective Surgical Approach

To report a case of uveitis-glaucoma-hyphema (UGH) syndrome secondary to intraocular lens (IOL) haptic-iris friction, highlighting the importance of a thorough clinical evaluation and an innovative surgical approach to optimize visual outcomes. UGH syndrome is a rare but significant complication following cataract surgery that can severely impact visual function and quality of life. This case emphasizes the role of tailored interventions in preserving both refractive stability and patient well-being.

Ophthalmology Department, Unidade Local de Saúde de São João

A 60-year-old male presented to the emergency department of Unidade Local de Saúde de São João with blurred vision in the left eye (OS). His history was notable for prior
phacoemulsification with toric IOL implantation at 80º. Examination revealed 3+ pigmented Tyndall, endothelial pigment deposits, and a superior transillumination defect where the IOL haptic was visible. Intraocular pressure was 19 mmHg. Best-corrected visual acuity (BCVA) was 6/10. Pupil dilation disclosed a capsulorhexis tear aligned with the upper haptic position (80º). Fundoscopy was unremarkable. The diagnosis of UGH syndrome was established, and initial management included topical dexamethasone, cyclopentolate, and prednisolone ointment. Symptoms improved but recurred whenever the patient bent over. Given his active lifestyle and the necessity of maintaining astigmatic correction with a toric IOL, scleral fixation was avoided. Instead, the upper haptic causing iris friction was surgically excised to preserve toric alignment. Three months postoperatively, the patient remained asymptomatic, resumed normal activities without medication, and achieved a BCVA of 10/10. This outcome was likely due to fibrosis within the capsular bag, which stabilized the lens and prevented displacement.

This case underscores the importance of a detailed patient evaluation to identify mechanical factors contributing to UGH syndrome. A customized, innovative surgical approach allowed for symptom resolution while maintaining visual acuity and avoiding anisometropia. By preserving the patient's refractive status, this strategy ensured a seamless return to daily activities without the need for additional optical correction. Such individualized interventions should be considered in similar cases to optimize both functional and quality-of-life outcomes.