A patient undergoes uneventful phacoemulsification with in-the-bag IOL. Six months postoperatively, the eye develops raised IOP, corneal edema, anterior uveitis, and trabecular meshwork pigmentation. The condition most likely responsible is:
- A Pseudoexfoliation syndrome unmasked by surgery
- B Retained lens cortex causing phacoanaphylactic uveitis
- C Toxic anterior segment syndrome (TASS) with delayed presentation
- D Pigment dispersion from IOL-iris chafing (UGH syndrome) ✓
Explanation
UGH (Uveitis-Glaucoma-Hyphema) syndrome classically occurs with anterior chamber IOLs or sulcus-placed single-piece IOLs whose haptics chafe the iris, uvea, and ciliary body. The chronic mechanical trauma disperses iris pigment (causing trabecular meshwork pigmentation and pigmentary glaucoma) and causes uveal inflammation (uveitis) and recurrent hyphema from damaged iris/ciliary body vessels. With in-the-bag IOL, late UGH may occur if the lens rotates (especially toric IOLs in a floppy bag), the haptic erodes through the posterior capsule into the sulcus, or in patients with zonular weakness. Management involves IOL repositioning, exchange, or explantation. TASS has an acute onset (within 24 hours post-surgery) and lacks hyphema.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.