International Journal of Keratoconus and Ectatic Corneal Diseases

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VOLUME 5 , ISSUE 1 ( January-April, 2016 ) > List of Articles

RESEARCH ARTICLE

Pathogenesis of Fixed Dilated Pupil (Urrets-Zavalía Syndrome) after Deep Lamellar Keratoplasty in Keratoconus

José RC Reis, Alberto Diniz-Filho, Fábio M Rocha

Citation Information : Reis JR, Diniz-Filho A, Rocha FM. Pathogenesis of Fixed Dilated Pupil (Urrets-Zavalía Syndrome) after Deep Lamellar Keratoplasty in Keratoconus. Int J Kerat Ect Cor Dis 2016; 5 (1):32-34.

DOI: 10.5005/jp-journals-10025-1118

Published Online: 01-04-2016

Copyright Statement:  Copyright © 2016; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Purpose

To present a case series of patients that developed Urrets-Zavalia syndrome (UZS) after deep anterior lamellar keratoplasty (DALK) for treating keratoconus and discuss the mechanisms for the syndrome.

Materials and methods

Retrospective chart analysis of patients who developed UZS after DALK at the Cornea Unit, Hospital São Geraldo, Federal University of Minas Gerais.

Results

We present a series of 3 patients with features consistent with UZS, after undergoing DALK. Elevated intraocular pressure (IOP) was noted in the early postoperative period in 2 cases, despite the fact that the other case reported eye pain, headache, and nausea at the night after the surgery with undocumented IOP. Although at different extents, the pupil remained atrophic and dilated in all 3 eyes, and 2 of them developed anterior subcapsular cataract.

Conclusion

Iris ischemia resulting from occlusion of iris root vessels due to elevated IOP higher than diastolic blood pressure causes UZS. Elevated IOP should be monitored, especially in young patients with low diastolic blood pressure, in order to avoid the occurrence of the syndrome.

How to cite this article

Reis JRC, Diniz-Filho A, Rocha FM, Torquetti L. Pathogenesis of Fixed Dilated Pupil (Urrets-Zavalía Syndrome) after Deep Lamellar Keratoplasty in Keratoconus. Int J Kerat Ect Cor Dis 2016;5(1):32-34.


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  1. Fixed, dilated pupil, iris atrophy and secondary glaucoma. Am J Ophthalmol 1963 Aug; 56: 257-265.
  2. Management of keratoplasty in the early stages. Br J Ophthalmol 1977 Feb;61(2):89-91.
  3. Irreversible mydriasis following keratoplasty in keratoconus [proceedings]. Acta Ophthalmol Suppl 1975;(125):45-46.
  4. Urrets-Zavalia syndrome. Bull Soc Ophtalmol Fr 1978 Aug-Sep;78(8-9):579-584.
  5. Fixed dilated pupil (Urrets-Zavalia syndrome) in corneal dystrophies. Cornea 2004 Jan;23(1):81-83.
  6. Fixed dilated pupil (Urrets-Zavalia syndrome) and anterior subcapsular cataract formation after Descemet stripping endothelial keratoplasty. Cornea 2009 Dec;28(10):1184-1186.
  7. Urrets-Zavalia syndrome following Descemet's stripping endothelial keratoplasty triple procedure. Clin Exp Ophthalmol 2011 Jan;39(1):85-87.
  8. Urrets-Zavalia syndrome following trabeculectomy. Br J Ophthalmol 2000 Mar;84(3):338-339.
  9. Urrets-Zavalia syndrome as a complication of argon laser peripheral iridoplasty. Br J Ophthalmol 2007 Apr;91(4):427-429.
  10. Urrets-Zavalia syndrome following goniotomy in a child. J AAPOS 2012 Jun;16(3):312-313.
  11. The fixed dilated pupil after cataract surgery – is it related to intraocular use of hypromellose? Br J Ophthalmol 1993 Oct;77(10):639-641.
  12. Urrets-Zavalia syndrome following iatrogenic pupil dilation in eyes with pigment dispersion. Can J Ophthalmol 2009 Apr;44(2):216-217.
  13. Sensitivities of ocular tissues to acute pressure-induced ischemia. Arch Ophthalmol 1975 Apr;93(4):267-274.
  14. Big-bubble technique to bare Descemet's membrane in anterior lamellar keratoplasty. J Cataract Refract Surg 2002 Mar;28(3):398-403.
  15. Fixed dilated pupilla as a common complication of deep anterior lamellar keratoplasty complicated with Descemet membrane perforation. Eur J Ophthalmol 2013 Mar-Apr;23(2):164-170.
  16. How good is transplantation of corneal parts compared with penetrating keratoplasty? Cornea 2010 Nov;29 (Suppl 1):S48-S51.
  17. Randomized clinical trial of deep lamellar keratoplasty vs penetrating keratoplasty. Am J Ophthalmol 2002 Aug;134(2):159-165.
  18. Comparison of deep lamellar keratoplasty and penetrating keratoplasty in patients with keratoconus. Ophthalmology 2004 Sep;111(9):1676-1682.
  19. Deep lamellar endothelial keratoplasty visual acuity, astigmatism, and endothelial survival in a large prospective series. Ophthalmology 2005 Sep;112(9):1541-1548.
  20. Penetrating keratoplasty versus deep anterior lamellar keratoplasty for the treatment of keratoconus. Int Ophthalmol 2010 Dec;30(6):675-681.
  21. Iris ischaemia following penetrating keratoplasty for keratoconus (Urrets-Zavalia syndrome). Cornea 1995 Nov;14(6):618-622.
  22. Fixed dilated pupil following deep lamellar keratoplasty (Urrets-Zavalia syndrome). Br J Ophthalmol 2002 Jan;86(1):115-116.
  23. The effect of intraocular pressure on the pupil size. Arch Ophthalmol 1970 Jun;83(6):729-733.
  24. Arterial pressure monitoring in offspring of hypertensive individuals at a day-care center. Rev Assoc Med Bras 2008 Mar-Apr;54(2):163-166.
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