Intraocular Lens-Associated Uveitis-Glaucoma-Hyphema Syndrome.

Abstract

To characterize the clinical presentation, timing of onset, management strategies, and outcomes of contemporary intraocular lens (IOL)-associated uveitis-glaucoma-hyphema (UGH) syndrome. Retrospective clinical cohort study. Two hundred thirty-two eyes of 226 patients diagnosed with UGH syndrome at a tertiary academic referral center between October 2015 and December 2025. Medical records were reviewed for demographic data, IOL characteristics, clinical findings, imaging features, management strategies, and visual and intraocular pressure (IOP) outcomes. Eyes were stratified by time from causative surgery to diagnosis as early-onset (≤1 year), intermediate-onset (1-10 years), or late-onset (>10 years). Clinical presentation features, recurrent disease, best-corrected visual acuity (BCVA), IOP at 12 months, and persistent ocular hypertension after UGH resolution. The mean age at UGH syndrome diagnosis was 68.4 ± 13.7 years. Posterior chamber IOLs accounted for 92.2% of cases, of which 76.2% were located in the sulcus. Among sulcus-positioned IOLs with documented configuration, 67.3% were single-piece IOLs and 32.7% were three-piece IOLs. The median time from causative surgery to diagnosis was 4.8 years. The most common findings were IOL-iris or ciliary body contact (77.3%), pigment dispersion (59.3%), transillumination defects (50.0%), and intraocular hemorrhage (48.7%). Recurrent disease occurred in 46.2% of eyes. Surgical intervention was performed in 77.2% of eyes. Median IOP improved from 19.8 mmHg before treatment to 15.0 mmHg at 12 months, while median BCVA improved from 0.40 to 0.30 logMAR. Persistent ocular hypertension occurred in 59.3% of eyes. Late-onset disease was associated with higher rates of pseudophacodonesis, Soemmering ring formation, and recurrent episodes. Contemporary UGH syndrome most commonly involves posterior chamber IOLs and frequently presents years after surgery. Late-onset disease is characterized by pseudophacodonesis, Soemmering ring formation, and recurrent episodes, while persistent ocular hypertension is common despite treatment.