Uveitis–glaucoma–hyphema syndrome after secondary intraocular lens implantation: incidence and clinical features in a real-world cohort

To evaluate the incidence and clinical characteristics of uveitis–glaucoma–hyphema (UGH) syndrome after secondary intraocular lens (IOL) implantation and to assess its distribution according to fixation approach.

This retrospective cohort study included patients undergoing secondary IOL implantation without capsular support between May 2018 and February 2025 at a tertiary referral centre. 0000-0002-0367-1446 Eyes received scleral-sutured posterior chamber IOLs (n = 33) or retropupillary iris-claw IOLs (n = 44), with technique selection based on ocular anatomy. Eyes with pre-existing uveitis were excluded. UGH syndrome diagnosis required imaging confirmation of IOL–uveal contact by anterior segment OCT (Anterion®, Heidelberg Engineering), performed as part of the institutional protocol in all suspected cases. UGH syndrome was classified as complete or incomplete using predefined clinical criteria. Analyses were descriptive and unadjusted.

UGH developed in 14 of 77 eyes (18.2%). Incidence was higher in the scleral-sutured group (12/33, 36.4%) than in the iris-claw group (2/44, 4.5%) (Fisher exact test, p = 0.0006), with an unadjusted risk ratio of 8.0 (95% CI 1.9–33.3). Most cases were managed medically; two required surgical intervention: one IOL exchange and one IOL removal leaving the eye aphakic due to extensive macular atrophy. No eye suffered permanent vision loss directly attributable to UGH syndrome. Thirteen of 14 cases occurred in left eyes.

In this real-world cohort, UGH occurred predominantly in anatomically high-risk eyes undergoing scleral-sutured fixation. These findings suggest a potential interaction between baseline ocular vulnerability and fixation technique, underscoring the importance of individualized surgical planning and postoperative monitoring.