A Case of Uveitis-Hyphema-Glaucoma Syndrome due to ExPRESS Miniature Implantation

Purpose: To report a case of a 69-year-old patient who developed uveitis-glaucoma-hyphema syndrome after an uneventful EX-PRESS (Optonol, Ltd. Neve Ilan, Israel) mini shunt surgery for advanced primary open angle glaucoma and to discuss management options and clinical implications. Uveitis-glaucoma-hyphema syndrome is a rare but serious complication usually described after cataract surgery. It is often described in anterior chamber intraocular lenses, sulcus lenses, as well as malpositioned or subluxed lenses resulting in chafing of the lens-iris interface. Clinical manifestations include increased intraocular pressure, anterior chamber inflammation, and recurrent hyphema. Patient and Methods: We report a case of a 69-year-old African American man who developed uveitis-glaucoma-hyphema syndrome 8 years after uneventful implantation of an EX-PRESS miniature shunt. Slit-lamp examination demonstrated persistent inflammation without evidence of iris atrophy nor IOL dislocation; however, gonioscopy demonstrated localized iris atrophy under the shunt with surrounding iris billowing and a layered hyphema. Results: A localized laser iridoplasty around the shunt was performed leading to resolution of uveitis and hyphema. No other complications occurred during follow-up. Conclusions: Given the increasing prevalence of glaucoma procedures involving implants, uveitis-glaucoma-hyphema syndrome may become more prevalent as new sources of intraocular devices may cause potential complications. Laser iridoplasty provides a minimally invasive approach to treating a localized source of chafing and reduce further surgical intervention.https://scholarlycommons.henryford.com/merf2020caserpt/1136/thumbnail.jp