Urrets-Zavalia syndrome in different methods of keratoplasty

Foroutan, Ali; Tabatabaei, Seyed Ali; Soleimani, Mohammad; Nekoozadeh, Shahbaz

doi:10.18240/ijo.2016.09.22

Cited by 6 publications

(7 citation statements)

References 13 publications

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“…However, others have suggested that the use of viscoelastic agents may not have much impact on the occurrence of UZS, because no iris atrophy has been observed during cataract surgery [ 5 ] wherein viscoelastic agents are widely used. It is also notable that leaving gas bubbles or injecting air into the anterior chamber of a phakic eye can cause pupillary blockage and increased IOP, leading to the occurrence of UZS [ 6 , 13 ]. Some believe that, although mannitol is administered before surgery, the sudden increase in IOP due to the formation of large gas bubbles may offset the action of mannitol and cause iris ischemia [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Since Urrets-Zavalia syndrome (UZS) was first reported in 1963 [ 1 ], it has been defined as a fixed wide pupil after intraocular surgeries that has not been affected by pupil-dilation medicine—including atropine and topicamide—or clear etiology, including preoperative uveitis, traumatic iris defects, preoperative pupillary abnormalities, gonioplasty, iridocorneal endothelial syndrome, excision of iris cysts etc. UZS has been widely observed in patients who undergo ophthalmological surgeries, such as penetrating keratoplasty (PKP) for keratoconus or corneal dystrophy [ 2 ]; cataract surgery [ 3 ]; intraocular lens implantation [ 4 ]; trabeculectomy [ 5 ]; deep lamellar keratoplasty [ 6 , 7 ]; Descemet-stripping endothelial keratoplasty (DSEK) [ 6 ]; Descemet membrane endothelial keratoplasty (DMEK) [ 8 ]; argon laser peripheral iridoplasty [ 9 ]; and goniotomy [ 10 ]. Due to the fixed and dilated pupils associated with UZS, in addition to discomfort under strong light, UZS affects patients’ best-corrected visual acuity and causes great inconvenience and pain.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors of Urrets-Zavalia Syndrome after Penetrating Keratoplasty

Wang

Gao

et al. 2022

JCM

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Objective: The objective of this study was to analyze the clinical features and risk factors of Urrets-Zavalia syndrome (UZS) after penetrating keratoplasty (PKP). Methods: The medical records of 152 patients who underwent PKP at the Department of Ophthalmology, Tongji Hospital, between January 2014 and December 2016 were retrospectively reviewed. UZS was diagnosed based on pre- and post-operative pupillary findings. The relationships among the primary disease, postoperative intraocular pressure (IOP), and the incidence of UZS were statistically analyzed. The pupillary changes during the follow-up period were studied. Results: Among the 152 included patients, 23 were diagnosed with UZS, with an incidence of 15.13%. The primary diseases of the UZS patients were keratoconus (eight cases, 34.78%), viral keratitis (six cases, 26.08%), leukoma (four cases, 17.39%), fungal corneal ulcer (two cases, 8.70%), corneal endothelial decompensation (two cases, 8.70%), and corneal degeneration (one case, 4.35%). The incidence of UZS in keratoconus patients was higher than that in patients with fungal corneal ulcer (42.11% versus 6.25%, p = 0.003); In addition, the transient postoperative high IOP was not significantly related to the incidence of UZS in keratoconus patients in our study (p = 0.319). Twenty-one patients with UZS were followed up for >6 months, seven of whom (33.33%) recovered spontaneously (within the range of 48 days to 1.5 years). Conclusion: In our study, the incidence of UZS after PKP was 15.13%, and 33.33% of these patients recovered spontaneously. UZS may be more likely to occur in patients with keratoconus. Postoperative transient high IOP may increase the incidence of UZS after PKP for keratoconus.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk Factors of Urrets-Zavalia Syndrome after Penetrating Keratoplasty

Wang

Gao

et al. 2022

JCM

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“…There may be a correlation between air injection in AC and the toxic effect of oxygen on the crystalline lens leading to cataract formation, iris ischemia, and pupil dilation. [ 9 ]…”

Section: Discussionmentioning

confidence: 99%

Iridoplasty of fixed-dilated pupil (Urrets-Zavalia syndrome) after deep anterior lamellar keratoplasty

Ntora

Ziakas

2017

Oman J Ophthalmol

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A 38-year-old woman with advanced keratoconus initially developed Urrets-Zavalia Syndrome (UZS) in the left eye after deep anterior lamellar keratoplasty. During the uneventful surgery, a 7-mm-wide pupil unresponsive to light was noticed. On the first postoperative day, intraocular pressure (IOP) was elevated up to 45 mmHg with shallow anterior chamber (AC). A peripheral iridotomy in 2 o’clock position was conducted and a fixed combination of brinzolamide 1% and timolol 0.5% was administered topically. In the subsequent postoperative period, IOP was successfully reduced, but the patient reported severe photophobia, glare, and decreased vision. Twelve months after surgery, her best-corrected visual acuity (BCVA) was 20/200, the fixed-dilated pupil persisted, iris was atrophic, and lens opacities were detected. She was submitted for phacoemulsification cataract surgery combined with iridoplasty using the closed chamber slipping suture technique. Three months after surgery, her BCVA was 20/25, pupil diameter remained stable at 4 mm, and glare symptoms were significantly reduced. A very adequate cosmetic outcome was also achieved. Iridoplasty in postkeratoplasty patient with unilateral UZS was effective in improving patient's visual function disability and restoring residual anisocoria. This technique can be applied as a single procedure or combined with another one for the management of UZS.

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“…At that time, the author associated the uncommon postoperative complication with the use of topical mydriatic agents (atropine). Later on, this syndrome was described in association with other surgical procedures, such as different methods of keratoplasty ( Maurino et al , 2002 ; Minasian and Ayliffe, 2002 ; Srinivasan and Patnaik, 2004 ; Fournié et al , 2009 ; Anwar et al , 2012 ; Bozkurt et al , 2012 ; Foroutan et al , 2016 ), intracameral gas injection for the treatment of corneal hydrops ( Aralikatti et al 2008 ), trabeculectomy ( Jain et al , 2000 ), goniotomy ( Chelnis et al , 2012 ; Walton, 2013 ), intraocular lens implantation ( Yuzbasioglu et al , 2006 ; Park et al , 2008 ; Pérez-Cambrodí et al , 2013 ; Narang et al 2017 ), cataract surgery ( Monson et al , 1992 ), argon laser retinal photocoagulation ( Lifshitz and Yassur, 1988 ), 360-degree peripheral iridoplasty ( Espana et al , 2007 ), and anterior chamber foreign body removal ( Totuk et al , 2018 ). The exact mechanism of Urrets-Zavalia syndrome (UZS) is still unknown.…”

Section: Introductionmentioning

confidence: 99%

Urrets-Zavalia syndrome following cataract surgery in dogs: A case series

Cantero¹,

Leiva²,

Gaztelu³

et al. 2022

Open Vet J

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Background: In human medicine, Urrets-Zavalia syndrome (UZS) is a well-recognized but uncommon postoperative complication characterized by a fixed dilated pupil, accompanied by iris atrophy and glaucoma. Although it was originally reported in 1963 after penetrating keratoplasty surgery for keratoconus, it has been associated with various ophthalmic procedures such as cataract surgery. The condition has not been previously published in the veterinary literature. Case Description: Three client-owned diabetic dogs that developed UZS´s triad after cataract surgery are described. Despite uneventful phacoemulsification in the six eyes, five developed moderate-to-severe postoperative ocular hypertension. Although intraocular pressure (IOP) spikes were initially controlled, fixed dilated pupils accompanied by iris atrophy and chronic ocular hypertension were seen in the five affected eyes. Aggressive medical and surgical management maintained vision in three of those eyes. In one eye, uncontrolled IOP led to blindness. Conclusion: This is the first published description of UZS in dogs, occurring after phacoemulsification. Although no exact, demonstrable causative element could be determined, we believe that should be considered a triggering condition for this syndrome, as it directly affects the ocular blood flow autoregulation and intrinsic uveal tissue integrity. Until the contrary is proved, diabetes mellitus might be considered as a risk factor for developing this syndrome after cataract surgery in dogs.

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Urrets-Zavalia syndrome in different methods of keratoplasty

Cited by 6 publications

References 13 publications

Risk Factors of Urrets-Zavalia Syndrome after Penetrating Keratoplasty

Risk Factors of Urrets-Zavalia Syndrome after Penetrating Keratoplasty

Iridoplasty of fixed-dilated pupil (Urrets-Zavalia syndrome) after deep anterior lamellar keratoplasty

Urrets-Zavalia syndrome following cataract surgery in dogs: A case series

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