Urrets-Zavalia syndrome after Descemet membrane endothelial keratoplasty

European Journal of Ophthalmology
Christoph HoltmannGerd Geerling

Abstract

To report a case of Urrets-Zavalia syndrome (UZS) after Descemet membrane endothelial keratoplasty (DMEK). A 74-year-old woman with Fuchs endothelial dystrophy and inconspicuous ocular history developed UZS after DMEK surgery. The intraoperative and postoperative course is presented. After uneventful DMEK surgery, intraocular pressure was elevated up to 40 mm Hg on the first postoperative day. A small bleed from the peripheral wide-open iridectomy in the 12 o'clock position in the otherwise deep anterior chamber was observed. On the sixth postoperative day, a 4-mm-wide pupil, nonreactive to light, was noted. One year after surgery, the fixed medium mydriasis (4 mm) persisted and best-corrected vision was 0.1 logMAR. No pupillary reaction was noted after application of 0.2% or 2% pilocarpine. Filling the anterior chamber with air to secure fixation of a grafted Descemet membrane carries the risk of early acute postoperative ocular hypertension. This can lead to iris sphincter defects resulting in a fixed dilated pupil after DMEK surgery. Large patent iridectomy in the 12 o'clock position is insufficient to prevent this. Patients undergoing DMEK surgery should be informed about this potential complication.

References

Aug 1, 1963·American Journal of Ophthalmology·A URRETS ZAVALIA
May 1, 1936·The British Journal of Ophthalmology·A J Hall
Dec 3, 2008·Journal of Refractive Surgery·Shin Hae ParkSuk Woo Yang
Jan 31, 2012·American Journal of Ophthalmology·Miguel NaveirasGerrit R J Melles
Jun 30, 2012·The American Journal of the Medical Sciences·Daniel Villarreal
Nov 26, 2013·Cornea·Mark S Gorovoy

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Citations

Nov 26, 2015·Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft·K SpaniolG Geerling
Feb 3, 2018·Journal of Glaucoma·Adela KlezlovaEsther M Hoffmann
Jan 28, 2017·Cornea·Francisco Arnalich-MontielJosé Luis Hernández-Verdejo
Feb 3, 2021·Journal français d'ophtalmologie·R Guillon-RolfR Mouchel

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