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 Table of Contents  
Year : 2023  |  Volume : 3  |  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 Submission09-Oct-2022
Date of Acceptance21-Nov-2022
Date of Web Publication28-Apr-2023

Correspondence Address:
Rohit Dureja
Cornea and Anterior Segment Services, L. V. Prasad Eye Institute, GMR Varalakshmi Campus, Hanumanthawaka Junction, Visakhapatnam - 530 040, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJO.IJO_2630_22

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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

How to cite this URL:
Dureja R. Urrets-Zavalia syndrome after cataract surgery. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Jun 10];3:556-7. Available from: https://www.ijoreports.in/text.asp?2023/3/2/556/374961

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 Top

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[1] and a few after deep anterior lamellar keratoplasty,[2] and Descemet-stripping automated endothelial keratoplasty.[3] Kurtz et al.[4] 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.[5] 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.

Author contributions

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.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Urrets Zavalia A Jr. Fixed, dilated pupil, iris atrophy and secondary glaucoma. Am J Ophthalmol 1963;56:257-65.  Back to cited text no. 1
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.  Back to cited text no. 2
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.  Back to cited text no. 3
Kurtz S, Fradkin M. Urrets-Zavalia syndrome following cataract surgery. Case Rep Ophthalmol 2021;12:659-63.  Back to cited text no. 4
Narang P, Agarwal A, Ashok Kumar D. Single-pass four-throw pupilloplasty for Urrets-Zavalia syndrome. Eur J Ophthalmol 2018;28:552-8.  Back to cited text no. 5


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