Uveitis-glaucoma-hyphema syndrome secondary to cosmetic iris implants
D. Remove the cosmetic iris implants surgically
Herpetic keratouveitis can present with elevated pressure, anterior chamber cells, and keratic precipitates, as in this patient’s case. However, these findings are most commonly unilateral in herpetic disease.1 Thus, initiating oral acyclovir (choice C) would not be the most appropriate option.
Instead, on the basis of the initial presentation of anterior chamber cells, elevated IOP, and pigmented keratic precipitates, a diagnosis of uveitis-glaucoma-hyphema (UGH) syndrome secondary to the patient’s cosmetic iris implants was made. Initially conceived for use in patients with congenital or traumatic aniridia, iris implants were first used in 1994.2 A decade later, anterior chamber iris implants were marketed for cosmetic purposes. These cosmetic implants have been associated with multiple complications aside from UGH syndrome, including corneal decompensation, synechiae formation, iris and retinal neovascularization, and cataracts.3- 5