Uveitis-Glaucoma-Hyphema Syndrome and Corneal Decompensation in Association With Cosmetic Iris Implants

doi:10.1016/j.ajo.2009.06.008

American Journal of Ophthalmology

Volume 148, Issue 5, November 2009, Pages 790-793

https://doi.org/10.1016/j.ajo.2009.06.008 Get rights and content

Purpose

To report a case and management of uveitis-glaucoma-hyphema (UGH) syndrome and corneal decompensation associated with cosmetic iris implants.

Design

Interventional case report.

Methods

settings: Department of Ophthalmology, University of Minnesota School of Medicine. patients: A 29-year-old man presented with bilateral redness, severe pain, photophobia, and reduction in visual acuity. Examination revealed intraocular pressure (IOP) of 38 mm Hg and 40 mm Hg right and left eye respectively, bilateral conjunctival injection 3+, epithelial corneal edema, microhyphema, cells 3+ to 4+ and flare 2+, bilateral cosmetic iris implants, and surgical peripheral iridectomies. The patient was diagnosed with UGH syndrome and corneal decompensation associated with cosmetic iris implants. intervention: Immediate medical management of inflammation and elevated IOP, anterior segment imaging, specular microscopy, Humphrey 24-2 visual field (VF) testing; following failed conservative management, combined trabeculectomy and removal of the iris implants. main outcome measures: Anterior chamber inflammation and microhyphema, IOP, and corneal edema.

Results

Anterior segment imaging demonstrated bilateral implant-iris apposition and implant-angle structures apposition. Specular microscopy demonstrated a significant reduction of the number of endothelial cells. VF test demonstrated a right superior arcuate scotoma and a normal left VF. Following surgical treatment IOP normalized and inflammation and microhyphema subsided. However, mild corneal edema persisted.

Conclusion

Cosmetic iris implantation may lead to UGH syndrome and corneal decompensation. Therefore, its use should be reserved for patients with significant medical indications, and avoided in patients with intact natural iridies, until more short-term and long-term safety data are available.

Section snippets

Methods

A 29-year-old man with complaints of photophobia, redness, pain, and intermittent blurred vision over 4 months' duration was seen in the Department of Ophthalmology at the University of Minnesota in April 3, 2008. There was no prior history of glaucoma. One year prior to presentation he reports that he had uneventful bilateral cosmetic single-piece silicone cosmetic iris (NewIris, Kahn Medical Devices Corp, San Fernando, Panama) implantation followed by an uncomplicated early postoperative

Results

Anterior segment imaging with Visante optical coherence tomography (Carl Zeiss Meditec Inc, Dublin, California, USA) demonstrated bilateral implant-iris apposition and implant-angle structures apposition (Figure 2). Endothelial cell counts were markedly reduced (837 cells/mm² and 1083 cells/mm² right and left eye, respectively). Pachymetry measurements of the corneas were 500 μm right eye and 540 μm left eye. Humphrey 24-2 visual field tests demonstrated an early right superior arcuate scotoma

Discussion

Artificial iris implants have been used for management of traumatic or congenital iris defects. Two types of iris implants are available: iris diaphragm and iris-lens diaphragm. Iris diaphragms are designed to correct an iris defect in phakic patients,⁴ and are implanted into the capsular bag. Iris-lens diaphragms are used to correct both iris defects and refractive errors in aphakic patients. These are available in a power range from +10.0 to +30.0 diopters, and are implanted into the ciliary

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Cited by (48)

Secondary pigmentary glaucoma following cosmetic laser treatment to alter iris colour
2023, Contact Lens and Anterior Eye
Cosmetic alteration of iris colour with implants, along with its secondary complications, is already well described in the literature. However the use of cosmetic iris laser is relatively novel. We report on a rare case of bilateral secondary pigmentary glaucoma, in a young patient who underwent such a treatment to cause a change in iris pigmentation. Data on the safety of such procedures are lacking. Ophthalmic healthcare professionals should be aware of the potentially devastating consequences and encourage caution in patients seeking this novel treatment.
Intraocular Lens Complications: Decentration, Uveitis–Glaucoma–Hyphema Syndrome, Opacification, and Refractive Surprises
2021, Ophthalmology
Citation Excerpt :
Uveitis–glaucoma–hyphema syndrome can appear early after surgery or many years later. A variety of causes has been described, such as a misplaced 1-piece IOL in the sulcus,20 a large capsulorrhexis-inducing tilt,25 cosmetic iris implants,35 or simply isolated pseudophacodonesis.36 One report described UGH syndrome 14 years after initial cataract surgery resulting from progression of Soemmering ring displacing a haptic that was placed inadvertently in the sulcus.37
As cataract surgery has evolved, intraocular lens (IOL) complications are rare. The purpose of this review was to report the incidence, diagnosis, and management of IOL decentrations, uveitis–glaucoma–hyphema (UGH) syndrome, IOL opacifications, and refractive surprises. Literature review was performed by searching PubMed, MEDLINE, EMBASE, and the Cochrane Controlled Trial Database and the reference lists of original studies as well as reviews. Intraocular lens decentrations and dislocations can appear at any time, particularly in patients with predisposing factors such as pseudoexfoliation, prior vitreoretinal surgery, or trauma. Recognizing when they require surgical intervention for UGH or to improve visual function is critical in limiting long-term sequela. Intraocular lens opacifications such as glistenings rarely require intervention, but others, such as subsurface nanoglistenings, calcifications, or discolorations, may require IOL exchange. Finally, despite our best efforts to enhance measurements and IOL calculations, refractive surprises still occur. Intraocular lens complications are uncommon with modern cataract surgery. A number of these complications require proper identification and care to optimize patient outcomes.
Complications of Cosmetic Artificial Iris Implantation and Post Explantation Outcomes
2021, American Journal of Ophthalmology
Citation Excerpt :
Similar to our results, Hoguet and associates13 reported a higher number of male patients (5 out of 7). The development of high IOP in 58.3% of eyes in this series is consistent with the 46.1%-71.4% range reported in previous studies.11-16 However, direct comparison is confounded by different and often poorly specified criteria used to define elevated IOP and glaucoma in various studies.
To report complications of cosmetic artificial iris implantation and explantation outcomes.
Retrospective case series.
Medical records of 12 patients (24 eyes) who presented to us after being implanted with cosmetic artificial irises elsewhere were reviewed. Data collected included baseline demographics, presenting symptoms, examination findings, and management outcomes.
Eight eyes had NewColorIris implants and 16 had BrightOcular implants. The mean interval from cosmetic iris implantation to presentation was 61.7 ± 60.0 months. The mean follow-up after explantation was 35.5 ± 38.1 months. Complications at presentation included iris abnormalities (11 eyes, 45.8%), elevated intraocular pressure (8 eyes, 33.3%), corneal edema (6 eyes, 25%), intraocular inflammation (5 eyes, 20.8%), and cataract (4 eyes, 16.7%). Surgical interventions included cosmetic iris removal (19 eyes, 79.2%), cataract extraction (7 eyes, 29.2%), corneal transplantation (7 eyes, 29.2%), and glaucoma surgery (4 eyes, 16.7%). Complications at the last follow-up examination included native iris defects (11 eyes, 45.8%), persistent glaucoma (7 eyes, 29.2%), cataract (5 eyes, 20.8%), corneal edema (4 eyes, 16.7%), and intraocular inflammation (2 eyes, 8.3%). The mean logarithm of the minimum angle of resolution was 0.56 ± 0.47 at presentation and 0.78 ± 0.88 at the last examination (P = .30). The mean intraocular pressure was 22.7 ± 15.8 mm Hg at presentation and 13.4 ± 6.99 mm Hg at the last examination (P = .02).
Cosmetic iris implantation was associated with serious complications at the time of presentation, and adverse sequelae persisted for years after explantation.
Late-onset uveitis-glaucoma-hyphema syndrome caused by Soemmering ring cataract
2019, Canadian Journal of Ophthalmology
To propose a late-onset mechanism for uveitis-glaucoma-hyphema (UGH) syndrome caused by Soemmering ring cataract (SRC) and describe surgical outcomes.
Retrospective interventional case series.
Patients developing UGH from anterior displacement of a haptic from a SRC.
A retrospective chart review was conducted of all patients referred to an anterior segment surgeon (J.C.H.) for intraocular lens (IOL) reposition/exchange between January 2003 and June 2017. Inclusion criteria consisted of all eyes with (i) a diagnosis of UGH syndrome, and (ii) SRC causing anterior displacement of a sulcus-fixated haptic with iris-haptic touch. Outcome measures were change in best corrected visual acuities (BCVA) and resolution of UGH findings.
Seven eyes of 7 patients developed UGH secondary to a SRC causing contact between the IOL optic/haptic and the iris/uvea. Diagnosis of UGH was made at a mean 9.1 years after IOL implantation; this was statistically different compared with UGH eyes with other mechanisms from our full UGH cohort (mean 5.4 years; p = 0.0367). The mean preoperative LogMAR BCVA of 0.45 improved to 0.37 after surgical intervention (p = 0.27). Resolution (or nearly full resolution) of UGH findings was achieved in all cases after SRC extraction and lens repositioning/exchange.
Late-onset UGH syndrome can be caused by SRC. Surgical removal of the SRC with IOL repositioning within the capsular bag resolves most if not all components of UGH. Anterior segment ultrasound biomicroscopy is a helpful modality for determining if a SRC is present by demonstrating anatomic relationships commonly obscured by a miotic pupil.
Suggérer un mécanisme tardif à l'origine du syndrome de UGH (uvéite-glaucome-hyphéma) secondaire à l'apparition d'un anneau de Soemmering (AS) et décrire les résultats chirurgicaux.
Étude rétrospective d'intervention d'une série de cas.
Patients chez lesquels est apparu un syndrome de UGH causé par le déplacement antérieur d'un haptique secondaire à un AS.
On a procédé à un examen rétrospectif des dossiers médicaux de tous les patients qui avaient été adressés à un chirurgien spécialisé dans le segment antérieur (J.C.H.) en vue du repositionnement/remplacement d'une lentille intraoculaire (LIO) entre janvier 2003 et juin 2017. Parmi les critères d'inclusion, mentionnons tous les yeux qui (i) avaient fait l'objet d'un diagnostic de syndrome de UGH, et (ii) qui présentaient un AS responsable du déplacement antérieur d'un haptique fixé au sulcus avec suture de l'haptique à l'iris. Les paramètres de mesure étaient la variation de la meilleure acuité visuelle corrigée (MAVC) et la disparition du syndrome de UGH.
Sept yeux de 7 patients ont présenté un syndrome de UGH secondaire à un AS qui entraînait un contact entre la LIO optique/haptique et l'iris/uvée. Le diagnostic de syndrome de UGH a eu lieu en moyenne 9,1 ans après l'implantation de la LIO; ce délai est statistiquement différent de celui noté dans les cas de syndrome de UGH découlant d'autres mécanismes dans notre cohorte UGH entière (moyenne de 5,4 ans; p = 0,0367). La MAVC moyenne préopératoire de 0,45 LogMAR s'est améliorée pour atteindre 0,37 après l'intervention chirurgicale (p = 0,27). La disparition complète (ou presque complète) du syndrome de UGH a été obtenue dans tous les cas après le retrait de l'AS et le repositionnement/remplacement de la LIO.
Le syndrome de UGH tardif peut être causé par un AS. L'excision chirurgicale de l'AS et le repositionnement de la LIO à l'intérieur du sac capsulaire soulagent la plupart des composantes du syndrome, si ce n'est toutes. La biomicroscopie ultrasonore du segment antérieur est utile pour vérifier la présence d'un AS en faisant ressortir des liens anatomiques habituellement obscurcis par une pupille myotique.
Bilateral BrightOcular iris implants necessitating explantation and subsequent endothelial keratoplasty
2018, American Journal of Ophthalmology Case Reports
To demonstrate the dangers associated with the BrightOcular iris implant, a model that had initially been touted as safer than its predecessors.
A 41-year-old male presented with decreased vision in both eyes, approximately two years following bilateral BrightOcular cosmetic iris implantation performed in Mexico. On initial consultation, he was found to have bilateral corneal decompensation with stromal edema and a significantly reduced endothelial cell count (ECC). On follow up 5 weeks later, his vision and corneal edema had further detriorated. In the following month, he underwent explantation of the cosmetic iris implants in both eyes. Significant corneal edema persisted in the right eye several months post-operatively, to the point of necessitating endothelial keratoplasty.
Despite numerous reports in the literature of the significant ocular complications that can arise secondary to cosmetic iris implantation, individuals continue to willingly undergo this surgery. Our intention with presenting this case to the ophthalmologic community is two-fold: to highlight the ongoing clinical risk that BrightOcular devices pose, despite being marketed as safer than the older NewColourIris models, and to stress the urgency with which cosmetic iris implants should be removed from the eye.
Uveitis-glaucoma-hyphema syndrome caused by dislocated Cionni endocapsular tension ring
2018, Canadian Journal of Ophthalmology

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Original articleUveitis-Glaucoma-Hyphema Syndrome and Corneal Decompensation in Association With Cosmetic Iris Implants

Purpose

Design

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

J Am Intraocul Implant Soc

J Cataract Refract Surg

J Am Intraocul Implant Soc

J Cataract Refract Surg

Ophthalmology

Original article
Uveitis-Glaucoma-Hyphema Syndrome and Corneal Decompensation in Association With Cosmetic Iris Implants