J Korean Ophthalmol Soc.  2008 Nov;49(11):1857-1861.

Three Cases of Urrets-Zavalia Syndrome Following Deep Lamellar Keratoplasty (DLKP)

• Ha CI
• Park JI
• Choi SK
• Lee JH
• Kim JH
• Lee DH

Abstract

PURPOSE
To report three cases of Urrets-Zavalia syndrome after deep lamellar keratoplasty.
CASE SUMMARY
A retrospective chart analysis of two men who underwent deep lamellar keraplasty after corneal chemical burns and one woman who was treated with deep lamellar keratoplasty due to lattice dystrophy was performed. To maintain the anterior chamber depth and prevent formation of a double anterior chamber after deep lamellar keratoplasty, air or gas (C3F8) was injected into the anterior chamber for all three cases. After injections of air or gas (C3F8) into the anterior chamber, pupillary blocks occurred and intraocular pressures increased. Afterwards, intraocular pressures were well-controlled, but the pupil remained irreversibly fixed and dilated despite the use of miotics.
CONCLUSIONS
Urrets-Zavalia syndrome, a postoperative complication, was first reported in a patient who underwent penetrating keratoplasty for keratoconus. This syndrome can also occur after deep lamellar keratoplasty on rare occasions.

Keyword

Deep lamellar keratoplasty; Fixed dilated pupil; Urrets-Zavalia syndrome

MeSH Terms

Anterior Chamber
Burns, Chemical
Corneal Transplantation
Female
Humans
Intraocular Pressure
Keratoconus
Keratoplasty, Penetrating
Male
Miotics
Postoperative Complications
Pupil
Retrospective Studies
Miotics

Figure

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  Figure 1. (A) Air was injected into the anterior chamber three times followed by 14% C3 F8 gas injection. After gas was removed (POD #11), the double anterior chamber was eliminated but the pupil remained irreversibly fixed and dilated despite the use of miotics. (B) Extracapsular cataract extraction with IOL implantation was done. And iridoplasty was conducted with a purse-string iris suture technique.

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  Figure 2. (A) Air was injected into the anterior chamber to prevent the formation of the double anterior chamber. (B) After air was removed, intraocular pressures were under control, but the pupil remained irreversibly fixed and dilated despite the use of miotics (POD #7).

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  Figure 3. (A) Air was injected into the anterior chamber several times because the operation resulted in the double anterior chamber. Double anterior chamber was eliminated, but the pupil remained irreversibly fixed and posterior synechia was sustained (POD#7). (B) After posterior synechiolysis and iridoplasty were done, the pupil margin became round and regular.

Reference

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