|Year : 2023 | Volume
| Issue : 2 | Page : 556-557
Urrets-Zavalia syndrome after cataract surgery
Cornea and Anterior Segment Services, L.V. Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, Andhra Pradesh, India
|Date of Submission||09-Oct-2022|
|Date of Acceptance||21-Nov-2022|
|Date of Web Publication||28-Apr-2023|
Cornea and Anterior Segment Services, L. V. Prasad Eye Institute, GMR Varalakshmi Campus, Hanumanthawaka Junction, Visakhapatnam - 530 040, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Keywords: Fixed and dilated pupil, intraocular pressure, Urrets-Zavalia syndrome
|How to cite this article:|
Dureja R. Urrets-Zavalia syndrome after cataract surgery. Indian J Ophthalmol Case Rep 2023;3:556-7
A 71-year-old male underwent uneventful left eye (LE) cataract extraction within the bag of intraocular lens (IOL) implantation. On postoperative day 01, best-corrected visual acuity (BCVA) in LE was 20/160 due to diffuse microcystic epithelial corneal edema with an intraocular pressure (IOP) of 32 mmHg. Oral antiglaucoma medication (AGM) was started along with routine medications. At his one-week follow-up visit, he complained of glare, more at night. BCVA in LE was 20/30 with a clear cornea, and IOP was 12 mmHg but the pupil was dilated (7 mm) and fixed with atrophic iris changes. Oral AGM was stopped and steroids were tapered gradually. At his one-month postoperative visit, he presented with persistent glare and a fixed dilated pupil of size 7 mm [Figure 1]. A clinical diagnosis of Urrets-Zavalia syndrome (UZS) was made, and he was started on pilocarpine 2% eye drops twice a day. No change in pupil size was noted during the next visit after one month. Treatment options of contact lenses or pupilloplasty were given, which the patient deferred.
|Figure 1: Slit-lamp image [diffuse illumination (a) and slit illumination (b)] of the left eye at 1 month postoperatively showing a fixed dilated pupil after cataract extraction with posterior chamber intraocular lens implantation|
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| Discussion|| |
UZS is a rare postoperative complication characterized by a fixed dilated pupil, iris atrophy, and secondary glaucoma. A majority of cases have been reported after penetrating keratoplasty and a few after deep anterior lamellar keratoplasty, and Descemet-stripping automated endothelial keratoplasty. Kurtz et al. described a case of UZS after femtosecond-assisted phacoemulsification. Increased IOP during and immediately after presentation of UZS has been noted in the majority of reported cases. However, the relationship between raised IOP and iris ischemia remains unclear. Currently, there is no specific treatment for pupillary atrophy leading to fixed dilated pupils in UZS. Narang et al. described single-pass four-throw pupilloplasty to prevent postoperative glare and narrow down the pupil size effectively. Contact lenses, corneal tattooing, and artificial iris implants are other treatment modalities available for glare reduction and cosmesis improvement.
RD: Design, data acquisition, data analysis, manuscript preparation, literature search, manuscript review
As the corresponding author, I had full access to all the data in the study and take full responsibility of the integrity of the data and the accuracy of the data analysis, as well as the decision to submit the data for publication.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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Maurino V, Allan BD, Stevens JD, Tuft SJ. Fixed dilated pupil (Urrets-Zavalia syndrome) after air/gas injection after deep lamellar keratoplasty for keratoconus. Am J Ophthalmol 2002;133:266-8.
Anwar DS, Chu CY, Prasher P, Bowman RW, Mootha VV. Features of Urrets-Zavalia syndrome after Descemet stripping automated endothelial keratoplasty. Cornea 2012;31:1330-4.
Kurtz S, Fradkin M. Urrets-Zavalia syndrome following cataract surgery. Case Rep Ophthalmol 2021;12:659-63.
Narang P, Agarwal A, Ashok Kumar D. Single-pass four-throw pupilloplasty for Urrets-Zavalia syndrome. Eur J Ophthalmol 2018;28:552-8.