Targeted Management of Uveitis-Glaucoma-Hyphema Syndrome by Selective Haptic Removal: A Case Report

PURPOSE: To describe the intraoperative diagnosis and targeted surgical management of Uveitis-Glaucoma-Hyphema (UGH) syndrome caused by a vertically misaligned intra-ocular lens (IOL) haptic that had escaped previous detection because of poor pharmacological mydriasis.

METHODS: Clinical records, surgical notes, referral letters, and intra-operative videos were retrospectively reviewed. A literature search was performed to identify comparable cases.

RESULTS: An 86-year-old man was referred to our clinic for IOL exchange after 10 months of recurrent anterior segment and vitreous hemorrhages, elevated intra-ocular pressure (IOP), anterior-chamber inflammation, and temporal iris transillumination-findings consistent with UGH syndrome. Planned surgery included pars plana vitrectomy (PPV) and IOL exchange. Intra-operatively, pharmacologic dilation remained inadequate; however, anterior-segment exploration revealed a temporal capsular-bag defect with the corresponding haptic displaced into the ciliary sulcus, lying perpendicular to the iris, while the toric IOL optic remained well centred and the bag mechanically stable. The dislocated haptic was carefully severed and removed, with the toric IOL intentionally preserved in its original, well-centered position. PPV cleared the vitreous haemorrhage, and retinal inspection was unremarkable. Post-operatively, topical antibiotics and corticosteroids were administered, and a topical carbonic anhydrase inhibitors/β-blocker controlled transiently elevated IOP. Best-corrected visual acuity improved from 0.25 to 0.63 Snellen decimal IOP normalised, and no further haemorrhagic or inflammatory episodes occurred during follow-up.

CONCLUSION: In selected cases of UGH syndrome, complete IOL exchange may be unnecessary. When the optic is well centred and the capsular bag intact, removal of the offending haptic alone can abolish pathological iris-IOL contact and resolve UGH manifestations.