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We propose 2 mechanisms of uveitis-glaucoma-hyphema (UGH) syndrome in 2 patients with intracapsular or in-the-bag single-piece acrylic intraocular lenses (IOLs). In the first case, pseudophacodonesis secondary to zonular laxity from pseudoexfoliation syndrome caused chafing of the posterior iris by the square-edged haptic. In the second case, focal capsular fibrosis around the square-edged haptics combined with anteriorly rotated ciliary processes in plateau iris configuration caused points of chafing. Extensive capsular fibrosis of the haptic in both cases precluded IOL exchange. In the first case, a capsular tension ring redistributed zonular tension and reduced symptoms. In the second case, endoscopic cyclophotocoagulation relieved areas of chafing and resolved symptoms. In-the-bag square-edged haptics of single-piece acrylic IOLs are a potential source of iridociliary chafing in certain situations. The mechanisms observed here should be considered to promptly diagnose and treat UGH., (Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Unlabelled: We report ultrasound biomicroscopy (UBM) evaluation of a paintball-related traumatic cataract with a posterior capsule tear. Slitlamp examination revealed anterior and posterior subcapsular cataracts with a suspicious tiny posterior capsule tear within the larger area of posterior bulging. Ultrasound biomicroscopy (35 MHz) confirmed the presence of a sub-1.0 mm posterior capsule tear, which was clearly observed intraoperatively and postoperatively. This is the first report illustrating the high performance of 35 MHz UBM in detecting a sub-1.0 mm posterior capsule tear., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

A 48-year-old man presented with hyphema, iridocyclitis, iridophacodonesis, and maculopathy after a contusive trauma. Ultrasound biomicroscopy identified a 90-degree cyclodialysis cleft with severe damage of the zonular fibers. Echographic B-scan examination revealed intravitreal hemorrhage and a 360-degree choroidal detachment. One month later, phacoemulsification was performed and a single-piece poly(methyl methacrylate) intraocular lens was inserted into the ciliary sulcus, with the haptic rotated toward the cyclodialysis cleft area. Postoperatively, the visual acuity improved and the intraocular pressure returned to normal. Ultrasound biomicroscopy showed closure of the cleft by reattachment of the ciliary body to the scleral spur. Optical coherence tomography revealed complete resolution of the macular and choroidal folds. Ultrasound biomicroscopy is a useful method for appropriate management of traumatic cyclodialysis cleft. In cases of small cyclodialysis clefts, with the surgical method we describe, the lens haptics apply directional force toward the sclera, fostering adherence of the ciliary body fibers.

We present a patient who had decreased visual acuity and hypotony in the left eye 2 months after removal of an anterior chamber phakic intraocular lens (pIOL). Gonioscopy demonstrated a cyclodialysis cleft at the 6 o'clock position in the region of the IOL footplate, which was confirmed by ultrasound biomicroscopy. A cyclodialysis cleft formation is one possible complication of pIOL removal. Careful gonioscopy evaluation before removal of pIOLs should be mandatory to assess the amount of fibrosis and the presence of synechia between the IOL and the surrounding tissues.

A 45-year-old man with retinitis pigmentosa experienced total aniridia in the left eye due to direct blunt trauma 2 years after uneventful bilateral phacoemulsification via a 3.5 mm clear corneal incision. Ultrasound biomicroscopy (UBM) of the left eye revealed no missing or stretched zonular fibers extending from the ciliary body to the anterior capsule, a few iris root remnants, a normal ciliary body, an in-the-bag acrylic intraocular lens, and Descemet's membrane dehiscence at the corneal tunnel through which the iris extruded. The eye recovered 20/25 visual acuity after 1 week. Transient hyphema and a rise in intraocular pressure were recorded. This is the first report of traumatic aniridia 2 years after phacoemulsification with UBM evidence of undamaged zonular apparatus. A UBM examination may be clinically helpful, especially when blood prevents accurate slitlamp examination of the anterior segment.

A 44-year-old man suffered traumatic 360-degree cyclodialysis in the left eye complicated by persistent hypotony, disc edema, maculopathy, and cataract. Treatment was removal of the cataract with phacoemulsification followed by insertion of a capsular tension ring with 2-point scleral suture fixation with polypropylene in the ciliary sulcus. A foldable acrylic posterior chamber intraocular lens was implanted in the capsular bag through the 4.1 mm corneal tunnel incision. The intraocular pressure responded well with resolution of hypotony, choroidal detachment, disc edema, and maculopathy. Ultrasound biomicroscopy showed complete closure of the cyclodialysis cleft.