Arthur Stella N, Wright Martha M, Kramarevsky Natalia, Kaufman Stephen C, Grajewski Alana L
Department of Ophthalmology, University of Minnesota, Minneapolis, MN 55455, USA.
Am J Ophthalmol. 2009 Nov;148(5):790-3. doi: 10.1016/j.ajo.2009.06.008. Epub 2009 Aug 5.
To report a case and management of uveitis-glaucoma-hyphema (UGH) syndrome and corneal decompensation associated with cosmetic iris implants.
Interventional case report.
Department of Ophthalmology, University of Minnesota School of Medicine.
A 29-year-old man presented with bilateral redness, severe pain, photophobia, and reduction in visual acuity. Examination revealed intraocular pressure (IOP) of 38 mm Hg and 40 mm Hg right and left eye respectively, bilateral conjunctival injection 3+, epithelial corneal edema, microhyphema, cells 3+ to 4+ and flare 2+, bilateral cosmetic iris implants, and surgical peripheral iridectomies. The patient was diagnosed with UGH syndrome and corneal decompensation associated with cosmetic iris implants.
Immediate medical management of inflammation and elevated IOP, anterior segment imaging, specular microscopy, Humphrey 24-2 visual field (VF) testing; following failed conservative management, combined trabeculectomy and removal of the iris implants.
Anterior chamber inflammation and microhyphema, IOP, and corneal edema.
Anterior segment imaging demonstrated bilateral implant-iris apposition and implant-angle structures apposition. Specular microscopy demonstrated a significant reduction of the number of endothelial cells. VF test demonstrated a right superior arcuate scotoma and a normal left VF. Following surgical treatment IOP normalized and inflammation and microhyphema subsided. However, mild corneal edema persisted.
Cosmetic iris implantation may lead to UGH syndrome and corneal decompensation. Therefore, its use should be reserved for patients with significant medical indications, and avoided in patients with intact natural iridies, until more short-term and long-term safety data are available.
报告一例与美容性虹膜植入物相关的葡萄膜炎-青光眼-前房积血（UGH）综合征及角膜失代偿的病例及处理。
介入性病例报告。
明尼苏达大学医学院眼科。
一名29岁男性，表现为双眼发红、剧痛、畏光及视力下降。检查发现右眼和左眼眼压分别为38 mmHg和40 mmHg，双眼结膜充血3级，角膜上皮水肿，微小前房积血，细胞3+至4+，房水闪辉2+，双眼有美容性虹膜植入物，以及手术周边虹膜切除术。该患者被诊断为与美容性虹膜植入物相关的UGH综合征及角膜失代偿。
立即进行炎症和眼压升高的药物治疗、眼前段成像、镜面显微镜检查、Humphrey 24-2视野（VF）检测；保守治疗失败后，行小梁切除术联合虹膜植入物取出术。
前房炎症和微小前房积血、眼压及角膜水肿。
眼前段成像显示双侧植入物与虹膜及植入物与房角结构的贴附。镜面显微镜检查显示内皮细胞数量显著减少。VF检测显示右眼上方弓形暗点，左眼VF正常。手术治疗后眼压恢复正常，炎症和微小前房积血消退。然而，轻度角膜水肿持续存在。
美容性虹膜植入可能导致UGH综合征和角膜失代偿。因此，其应用应仅限于有明确医学指征的患者，在有完整天然虹膜的患者中应避免使用，直至获得更多短期和长期安全性数据。
