2020–2021 BCSC Basic and Clinical Science Course™
11 Lens and Cataract
Chapter 11: Postoperative Surgical Course and Complications
Postoperative IOL Complications
UGH syndrome was first described in the context of rigid or closed-loop ACIOLs, as described in the Appendix. In modern surgery, it may also occur in patients with posterior chamber lenses owing to contact between lens haptics and uveal tissue in the posterior chamber. Single-piece acrylic IOL haptics should not be placed in the sulcus because of the high risk of UGH syndrome. The classic triad or individual components of the syndrome may also occur as a result of inappropriate IOL sizing, contact between the implant and vascular structures or the corneal endothelium, or defects in implant manufacturing.
Figure 11-11 Pupillary capture by an angulated posterior chamber IOL in a patient who was assaulted 2 months after lens implantation surgery.
(Courtesy of Steven I. Rosenfeld, MD.)
Figure 11-12 Late postoperative capsular block. Arrows show the posterior edge of the IOL and the posterior capsule containing turbid fluid.
(Courtesy of Chad Brasington, MD.)
Uveitis, glaucoma, and/or hyphema may respond to treatment with cycloplegics and topical anti-inflammatory or ocular hypotensive medications. If medical therapy does not sufficiently address the findings or if inflammation threatens either retinal or corneal function, IOL removal must be considered. This procedure may be complicated because of inflammatory scars, particularly in the anterior chamber angle or posterior to the iris. If such scarring is present, the surgeon may need to amputate the haptics from the optic and remove the lens piecemeal, rotating the haptic material out of the synechial tunnels to minimize trauma to the eye. In some cases, it is safer to leave portions of the haptics in place. Early lens explantation may reduce the risk of corneal decompensation and CME.
Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.