Three Cases of Urrets-Zavalia Syndrome Following Deep Lamellar Keratoplasty (DLKP)

Il Ha Chang; Il Park Jung; Kyue Choi Suk; Hyun Lee Jong; Hyoung Kim Jin; Hyung Lee Do

doi:10.3341/jkos.2008.49.11.1857

Journal List > J Korean Ophthalmol Soc > v.49(11) > 1008143

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Chang, Jung, Suk, Jong, Jin, and Do: Three Cases of Urrets-Zavalia Syndrome Following Deep Lamellar Keratoplasty (DLKP)

Original Article

J Korean Ophthalmol Soc 2008;49(11):1857-1861.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.11.1857

Three Cases of Urrets-Zavalia Syndrome Following Deep Lamellar Keratoplasty (DLKP)

Il Ha Chang, M.D., Il Park Jung, M.D., Kyue Choi Suk, M.D., Hyun Lee Jong, M.D., Hyoung Kim Jin, M.D., Hyung Lee Do, M.D.

Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Gyeonggi-do, Korea

Address reprint requests to Do Hyung Lee, M.D. Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine #2240 Daehwa-dong, Ilsan-gu, Goyang-si, Gyeonggi-do 411-706, Korea Tel: 82-31-910-7240, Fax: 82-31-911-7241, E-mail: dhlee@ilsanpaik.ac.kr

Received 10 July 2008 Accepted 28 February 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report three cases of Urrets-Zavalia syndrome after deep lamellar keratoplasty.

Case summary

A retrospective chart analysis of two men who underwent deep lamellar keraplasty after corneal chemical burns and one woman who was treated with deep lamellar keratoplasty due to lattice dystrophy was performed. To maintain the anterior chamber depth and prevent formation of a double anterior chamber after deep lamellar keratoplasty, air or gas (C₃ F₈) was injected into the anterior chamber for all three cases. After injections of air or gas (C₃ F₈) into the anterior chamber, pupillary blocks occurred and intraocular pressures increased. Afterwards, intraocular pressures were well-controlled, but the pupil remained irreversibly fixed and dilated despite the use of miotics.

Conclusions

Urrets-Zavalia syndrome, a postoperative complication, was first reported in a patient who underwent penetrating keratoplasty for keratoconus. This syndrome can also occur after deep lamellar keratoplasty on rare occasions.

Keywords: Deep lamellar keratoplasty, Fixed dilated pupil, Urrets-Zavalia syndrome

References

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Figure 1.

(A) Air was injected into the anterior chamber three times followed by 14% C₃ F₈ gas injection. After gas was removed (POD #11), the double anterior chamber was eliminated but the pupil remained irreversibly fixed and dilated despite the use of miotics. (B) Extracapsular cataract extraction with IOL implantation was done. And iridoplasty was conducted with a purse-string iris suture technique.

Figure 2.

(A) Air was injected into the anterior chamber to prevent the formation of the double anterior chamber. (B) After air was removed, intraocular pressures were under control, but the pupil remained irreversibly fixed and dilated despite the use of miotics (POD #7).

Figure 3.

(A) Air was injected into the anterior chamber several times because the operation resulted in the double anterior chamber. Double anterior chamber was eliminated, but the pupil remained irreversibly fixed and posterior synechia was sustained (POD#7). (B) After posterior synechiolysis and iridoplasty were done, the pupil margin became round and regular.

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