UGH syndrome after posterior chamber
lens implantation
S. P. B. Percival, M.B., F.R.C.S.
S. K. Das, M.S., D.O.
Scarborough, England
ABSTRACT
A case of uveitis-glaucoma-hyphema (UGH) syn-
drome is reported five years after implantation of a
modern lightweight posterior chamber lens. The oc-
casional incidence of uveitis and glaucoma following
extracapsular extraction, but with failed capsule fixa-
tion, is discussed.
Key Words: failed capsule fixation, posterior
chamber implants, pseudophakia,
uveitis-glaucoma-hyphema (UGH)
syndrome
Ridley's first generation posterior chamber implants
were associated with hemorrhage, uveitis and glau-
coma in some cases. This was considered to be in part
because of the weight of the lens. The following case
report draws attention to the fact that the UGH syn-
drome may occur even with a modern lightweight pos-
terior chamber implant, although the mechanism may
be different from that described by Ellingson l and by
Keates and Ehrlich2 when associated with poorly fin-
ished footplates of injection molded anterior chamber
lenses.
CASE REPORT
A 72-year-old man presented with a mature cataract
of the right eye. The examination was otherwise nor-
mal. The intraocular pressure (lOP) was 16 mm Hg
each eye. In March 1977, he underwent right ex-
tracapsular cataract extraction and implantation of a
Rayner-Pearce lathe cut one piece tripod lens, with
the upper foot fixed to the iris with a 10-0 nylon suture.
The postoperative course was uncomplicated. He was
treated with topical atropine (1%) and
betamethasone-neomycin and achieved good implant
Reprint requests to S.P.B. Percival, M.B., F.R.C.S., Consultant
Ophthalmic Surgeon, Scarborough Hospital, Scarborough, North
Yorkshire Y012 6QL, England.
200 AM INTRA-OCULAR IMPLANT SOC J-VOL 9, SPRING 1983
Fig.!. (Percival) Normal centration and fixation of Pearce sutured
tripod lens in 1977. Pupil dilated, visual acuity 20/20.
centration (Figure 1). The visual acuity was 20/20 with
a spectacle correction of +0.50 + 0.75 cyJ x 80.
After an asymptomatic period of nine months, the
patient complained of discomfort and blurred vision.
The implant was decentered slightly temporally and a
low grade uveitis was observed. The iris suture was
intact. Despite topical and sub-conjunctival steroid
therapy, the uveitis persisted and secondary glaucoma
developed. During the period May-September 1978,
the lOP ranged from 21 to 42 mm Hg. The inferior feet
of the implant had rotated out of the capsular bag and
the lens rocked sideways from its attachment at the
superior iris suture. Recurrences of uveitis and glau-
coma occurred in March-April 1979, December
1980, July-September 1981, when the lOP was ini-
tially 58 mm Hg, November-December 1981 and in
July 1982. The last of these attacks was accompanied by
a 4 mm hyphema and an lOP of 32 mm Hg.
At surgery, we noted that the iris suture had de-
graded so that the implant decentered nasally and the
infero-nasal foot pressed into the ciliary sulcus: The
implant was repositioned with Prolene sutures to the
superior and to the infero-temporal feet. There was
rapid and complete resolution of uveitis and glaucoma
postoperatively. Medication was discontinued. Visual
acuity is 20/40 and the condition has not recurred.
 COMMENT
Four additional cases of uveitis and glaucoma, but
without hyphema, have been noted among 450 ex-
tracapsular implantations performed over a six year
period by one of us (SPBP). Two followed insertion of a
Binkhorst two-loop lens in 1979 and one followed a
Boberg-Ans lens implantation in 1981. All of these
cases shared the common characteristic of failure of
capsule fixation with subsequent rotation of the lens.
The uveitis and glaucoma resolved in each case by
stabilizing the lens with long term miotic drops. The
fourth case occurred following the insertion of a Pearce
sutureless single piece posterior chamber tripod lens in
1980. This lens has a long superior haptic which is
designed to fit in the ciliary sulcus, but the inferior
haptics rotated out of the capsular bag postoperatively
causing instability and an intraocular pressure persist-
ing at 38 mm Hg. Complete resolution of uveitis and
glaucoma occurred following McCannel suturing to the
iris to stabilize the lens.
It is pertinent to remember that one of the few
disadvantages of posterior chamber lenses is that their
ultimate position is not visualized and that fixation by
the capsular bag method is not always foolproof. In this
report, we recognize a potential source of danger from
the use of a single piece posterior chamber lens, and
emphasize the importance of securing complete im-
plant stability within the eye.
REFERENCES
1. Ellingson FT: Complications with the Choyce Mark VIn ante-
rior chamber lens implant (uveitis-glaucoma-hyphema). Am
Intra-Ocular Implant Soc] 3:199-201, 1977
2. Keates RH, Ehrlich DR: "Lenses of Chance": Complications of
anterior chamber implants. Ophthalmology 85:408-414, 1978
AM INTRA-OCULAR IMPLANT SOC J-VOL 9, SPRING 1983
Pupil capture:
Prevention and management
Richard L. Lindstrom, M.D.
Wesley K. Herman, M.D.
Minneapolis, Minnesota
ABSTRACT
Pupil capture occurs in a small percentage of pa-
tients following posterior chamber lens implantation.
We noted a 3% incidence in 100 patients using sulcus
Hxated planar J-Ioop lenses, a 1% incidence using
sulcus Hxated angulated J-Ioop lenses, and a 1% inci-
dence in capsular bag Hxated flexible Y-loop lenses.
No patients lost vision from pupil capture, and no
clinically significant late complications were ob-
served. Pupil capture may be successfully treated in
the early postoperative period in some patients by
mydriasis and a noninvasive loop compression tech-
nique using Q-tips.
Key Words: lens implant subluxation, posterior
chamber lens, pseudophakia, pupil
capture
Pupil capture has been noted to occur in a small
percentage of patients following posterior chamber
lens implantation (Figure 1). The purpose of this paper
is to report the incidence of pupil capture that occurred
in three series of 100 consecutive posterior chamber
lens implantations, and to describe a simple,
nonsurgical technique for treating pupil capture in the
early postoperative period.
METHODS AND SUBJECTS
Three series of 100 consecutive posterior chamber
lens implants were evaluated in a retrospective fash-
ion. The surgeries were performed between January 1,
1978 and January 1, 1982. The first 100 patients' eyes
were implanted with planar J-Ioop posterior chamber
lenses (IOLAB 101 and Surgidev Style 17A). The sec-
ond 100 patients' eyes were implanted with J-Ioop
posterior chamber lenses with 10 angulated loops
(IOLAB 101K and Surgidev Style 17A). In both of these
series, the lens implants were placed with ciliary sulcus
fixation. The final 100 patients' eyes were implanted
with a modified V-loop posterior chamber lens with 10
angulated loops and reverse optic (Surgidev Style 20).
201