Fixed dilated pupil following deep lamellar keratoplasty (Urrets-Zavalia syndrome)

Fixed, dilated pupil after phakic intraocular lens implantation

“…4 They claim that the compressive theory cannot play a part in this instance, and this may support the theory of an intrinsic iris abnormality in keratoconus. 4 Jain et al 9 report 2 cases of this syndrome after trabeculectomy and determined that a peripheral iridectomy did not protect against this syndrome, as is believed by some investigators. In our case, increased IOP, iris ischemia, and fixed, dilated pupil developed despite a surgical peripheral iridectomy.…”

“…Mydriasis following PKP was first described by Casterviejo. [2][3][4] Gasset 5 estimated that this syndrome occurred in 5.8% of the patients he treated. He reported that in 24 of 445 eyes a fixed, dilated pupil developed, and he described glaucoma as a secondary phenomenon, not integral to the syndrome.…”

Update and review of Urrets-Zavalia syndrome

“…Our observations, in corroboration with those of other authors, indicate atropine does not increase the risk of UZS development (32,(44)(45) . In fact, it is questionable whether the use of these measures prevents iris injury (13) . The mechanisms underlying pupillary block remain controversial.…”

“…Other findings of UZS were subsequently reported, including peripheral synechiae, posterior subcapsular opacity, iris ectropion, pigmentary dispersion, and glaukomflecken (3)(4)(5)(6)(7)(8)(9)(10)(11) . Other procedures shown to be associated with UZS include trabeculectomy (TREC) (5) , deep anterior lamellar keratoplasty (DALK) (12)(13)(14)(15) , Descemet-stripping automated endothelial keratoplasty (DSAEK) (16)(17)(18) , cataract surgery (11,19) , goniotomy (20) , phakic intraocular lens implant (IOL) (21)(22)(23) , argon laser peripheral iridoplasty (ALPI) (7) , and octafluoropropane injection (C3F8) (24) . Although the reported incidence of UZS is low, the associated visual symptoms can cause limitations in activities of daily life requiring preventative measures by ophthalmic surgeons (7,14) .…”

Toxic anterior segment syndrome after cataract surgery secondary to subconjunctival gentamicin

“…An alternative explanation for 2 patients ending up with a fixed nonreactive pupil such as the Urrets-Zavila syndrome seems even less likely as we believe it has not been described after routine cataract surgery, and irreversible dilation occurs in less than 10% of these rare cases. 9 No additional cases have been encountered since all surgeons agreed to ensure subconjunctival gentamicin was kept strictly subconjunctival, and several thousand intraocular surgeries have taken place at this site since then. With only this modification, the first patient had successful second-eye cataract surgery by the same surgeon with no complications and remains happy, wearing a cosmetic contact lens on the left eye to reduce glare.…”