Cluster of Urrets-Zavalia syndrome: a sequel of toxic anterior segment syndrome

Abstract

Timely diagnosis, steroid therapy and close monitoring are the main keys for properly managing TASS. To our knowledge, we report, for the first time, the largest cluster of UZS occurring as a sequel of TASS.

Update and review of Urrets-Zavalia syndrome

“…Use of viscoelastic substances during surgery have been suspected as toxic to the iris sphincter and a cause of acute rises in IOP (10,11) . The use of miotics before and during surgery has been considered prophylactic by some authors and a risk factor of pupillary atrophy by others (4,10,18,25,28) . Urrets-Zavalia posited that iris compression against the peripheral cornea under the effect of intense mydriasis without compromising the ciliary body and pars plana was the most important factor related to the development of UZS (1,17) .…”

“…Mannitol, IOP control, the removal of air or gas in the anterior chamber, and iridectomy have all demonstrated utility in managing Urrets-Zavalia syndrome. position, and direct iris trauma have all been posited to contribute to the pathophysiology of UZS (7,8,10,25) . Early reports indicated the use of atropine in PK as associated with such complications (1) .…”

Toxic anterior segment syndrome – A sequel of uneventful cataract surgery

“…It has been frequently reported after adult cataract surgery and it has also been seen following paediatric cataract surgery. 2,3 TASS has been attributed to the introduction of toxins into the eye during surgery from glove talc, surgical instruments, drugs used intra-operatively, denatured ophthalmic viscosurgical devices (OVD) etc. In severe cases residual sequelae such as permanent corneal oedema and glaucoma occur.…”

Urrets-Zavalia syndrome after implantable Collamer lens placement

“…7 Possible causes for iris ischemia include acute postoperative increase in IOP 6,8 and viscoelastic material left in the anterior chamber angle. 9 However, UZS was usually reported in patients with normal IOP, 10,11,4 and none of the cases in Urrets-Zavalia's original article had elevated IOP.…”

“…There was a moderate anterior chamber reaction (not suggestive of TASS), which has been reported to be associated with UZS in some cases. 11 The most probable explanation for the increase in IOP is the retained viscoelastic material in the anterior chamber angle. The IOP was medically controlled within 3 days.…”