Case report: Urrets-Zavalia syndrome after phakic intraocular lens implantation

Session Details

Session Title: Presented Poster Session: Keratorefractive Surgery Results II

Venue: Poster Village: Pod 2

First Author: : S.Diniz PORTUGAL

Co Author(s): :    P. Gomes   I. Matias   P. Neves                 

Abstract Details

Purpose:

Urrets-Zavalia Syndrome (UZS) was first defined as a fixed and dilated pupil after penetrating keratoplasty for keratoconus in patients who receive mydriatics. Other ocular findings recently reported include peripheral and posterior synechiae, posterior subcapsular opacity, iris ectropion, pigmentary dispersion and glaukomflecken. The pathophysiological mechanisms remain uncertain, but iris ischemia and acute elevation of intraocular pressure (IOP) are most widely accepted. Rarely, UZS can occur in the context of phakic intraocular lens (pIOL) implantation, especially with iris-claw IOL. The authors describe the case of a 41-year-old patient with bilateral high myopia, submitted to anterior chamber iris-claw pIOL implantation, who developed UZS.

Setting:

This case report was based on the patient´s clinical examinations and follow-up performed in São Bernardo Hospital, Portugal.

Methods:

In this paper the authors present the case of a 41-year old female patient, with high myopia, that underwent an uneventful bilateral implantation of iris-claw pIOL – Artiflex ®.  There was no history of perioperative mydriatic use. In the immediate postoperative period, the patient presented with a fixed and dilated right pupil that not reacted to light or accommodation, accompanied by cells in the anterior chamber (AC) and increased IOP.

Results:

Six hours after surgery, right eye IOP was 45 mmHg and the patient received mannitol infusion; visual acuity(VA) without correction was 7/10 in both eyes. One week after procedure, using ocular hypotensive agents and corticoids, the patient presented fewer cells in AC and reduction of IOP. Two weeks after surgery, posterior synechiae and pigment deposits on the IOL were present; LASER iridotomy was enlarged. Six months after surgery, besides small reduction of the right pupil size, VA without correction was 9/10 in the right eye and 10/10 in the left eye, IOP was controlled and no inflammation in AC detected.

Conclusions:

A fixed and dilated pupil in UZS, even not causing a decrease in visual acuity, can cause halos, glare or photophobia, as well as cosmetic concerns. Reduction in pupil size is possible over time in less severe cases. The permanent mydriasis can originate peripheral anterior synechiae that occlude the angle and may conduct to a secondary angle-closure glaucoma. Preventing UZS is difficult because the precise cause of the syndrome remains uncertain. Clinicians performing phakic IOL implantation should be aware of this complication.

Financial Disclosure:

None