Large capsulorhexis related uveitis-glaucoma-hyphema syndrome managed by intraocular lens implant exchange and gonioscopy assisted transluminal trabeculotomy

Purpose: To report a case of uveitis-glaucoma-hyphema syndrome (UGHS) secondary to a large capsulorhexis with an intracaspular intraocular lens (IOL) managed with IOL exchange and gonioscopy assisted transluminal trabeculotomy (GATT). Case Report: A 73-year-old male patient presented with UGHS of the right eye in the setting of an intracapsular single-piece acrylic IOL with circumferential optic and partial haptics exposure due to a large capsulorhexis. In lieu of the patient's uncomplicated surgical history, subtle symptoms, and clinical findings, the diagnosis and referral was delayed until intraocular pressure reached a peak of 50 mmHg with recurrent anterior chamber cells. The patient underwent combined IOL exchange with placement of a 3-piece sulcus IOL and GATT, which finally resolved the UGHS. Conclusion: With respect to the increasing prevalence of intracapsular single-piece IOL implantation, it is important to recognize UGHS and thus fashion proper sized capsulorhexis to prevent this vision threatening complication. GATT may be considered to be one of the glaucoma surgeries combined with the IOL surgical procedures in UGHS

Age at natural menopause genetic risk score in relation to age at natural menopause and primary open-angle glaucoma in a US-based sample

Abstract Objective: Several attributes of female reproductive history, including age at natural menopause (ANM), have been related to primary open-angle glaucoma (POAG). We assembled 18 previously reported common genetic variants that predict ANM to determine their association with ANM or POAG. Methods: Using data from the Nurses’ Health Study (7,143 women), we validated the ANM weighted genetic risk score in relation to self-reported ANM. Subsequently, to assess the relation with POAG, we used data from 2,160 female POAG cases and 29,110 controls in the National Eye Institute Glaucoma Human Genetics Collaboration Heritable Overall Operational Database (NEIGHBORHOOD), which consists of 8 datasets with imputed genotypes to 5.6+ million markers. Associations with POAG were assessed in each dataset, and site-specific results were meta-analyzed using the inverse weighted variance method. Results: The genetic risk score was associated with self-reported ANM (P = 2.2 × 10–77) and predicted 4.8% of the variance in ANM. The ANM genetic risk score was not associated with POAG (Odds Ratio (OR) = 1.002; 95% Confidence Interval (CI): 0.998, 1.007; P = 0.28). No single genetic variant in the panel achieved nominal association with POAG (P ≥0.20). Compared to the middle 80 percent, there was also no association with the lowest 10th percentile or highest 90th percentile of genetic risk score with POAG (OR = 0.75; 95% CI: 0.47, 1.21; P = 0.23 and OR = 1.10; 95% CI: 0.72, 1.69; P = 0.65, respectively). Conclusions: A genetic risk score predicting 4.8% of ANM variation was not related to POAG; thus, genetic determinants of ANM are unlikely to explain the previously reported association between the two phenotypes