Uveitis-Glaucoma-Hyphema Syndrome Constanze Kortuem, Daniela Suesskind, Manfred Zierhut Centre for Ophthalmology University of Tuebingen, Germany

Ocular History  80 year old Caucasian woman  OS: feels pressure on eye and blurred vision since one day  seen abroad:  suspected posterior uveitis  posterior synechiae  vitreous cell infiltration  cataract extraction with IOL (2010)  YAG capsulotomy (2012)

General History  cardiac arrhythmia  arterial Hypertension  depression

First Presentation - Ocular Examination  VA: OD 20/25, OS 20/20  IOP: OD/OS 14/10 mmHg  OS: AC cells 2+, pseudophakic, no posterior synechiae in mydriasis, vital optic disc, CDR 0.7  OD: lens clear, no signs of intraocular inflammation, pale optic disc, CDR 0.7

Diagnosis anterior uveitis of unclear origin anterior uveitis of unclear origin

Treatment topical corticosteroids every hour topical corticosteroids every hour cycloplegics cycloplegics

Follow up – After 3 Days Ocular Examination  VA: OD 20/32, OS 20/25  IOP: OD/OS 14/14 mmHg  OS:  AC cells 1+,  Vitreal prolaps with hemorrhage into the AC

Follow Up – Anterior Segment

Follow up- After 6 Days Because of uncharacteristic ‘inflammation’ of anterior chamber, ultrasound was performed before hematological laboratory testing Because of uncharacteristic ‘inflammation’ of anterior chamber, ultrasound was performed before hematological laboratory testing

Follow up – After 6 Days US Partial posterior vitreous detachment Partial posterior vitreous detachment

Follow up – After 6 Days Ultrasound Biomicroscopy (UBM)  vitreous prolaps visible between IOL and iris

Follow up – After 6 Days Ultrasound Biomicroscopy (UBM) IOL with haptic in front of the capsular bag in the ciliary sulcus on the nasal side IOL with haptic in front of the capsular bag in the ciliary sulcus on the nasal side IOL with haptic intracapsular on the temporal side IOL with haptic intracapsular on the temporal side

Diagnosis  OS: UGH-Syndrome  based on  clinical findings  history (IOL)  ultrasound

Treatment slow reduction of local corticosteroids slow reduction of local corticosteroids relocation or IOL-extraction if recurrent inflammation or IOP increase relocation or IOL-extraction if recurrent inflammation or IOP increase follow-up examinations of optic disc to exclude low pressure glaucoma follow-up examinations of optic disc to exclude low pressure glaucoma

Conclusion first descriped by Ellingson 1978 first descriped by Ellingson 1978 AC-IOL which had contact to uveal tissue AC-IOL which had contact to uveal tissue PC-IOL nowadays: PC-IOL nowadays: unstable sulcus fixation unstable sulcus fixation zonular weekness (Pseudoexfoliatio lentis) zonular weekness (Pseudoexfoliatio lentis) trauma trauma postoperative occurence postoperative occurence normally weeks to months normally weeks to months may be several years may be several years reason for intraocular exchanges in ca. 10 % reason for intraocular exchanges in ca. 10 %