Urrets-Zavalia Syndrome in Different Methods of Keratoplasty
To report the prevalence of Urrets-Zavalia syndrome in different methods of keratoplasty.
In a retrospective study, we reviewed eyes which underwent penetrating keratoplasty (PKP), descemet stripping endothelial keratoplasty (DSEK) and deep anterior lamellar keratoplasty (DALK) from 2008 until 2012. Eyes with a documented postoperative fixed dilated pupil following surgery were considered as Urrets-Zavalia syndrome. Demographic data, ocular and drug history, pre and postoperative examinations were also reviewed.
Eight-hundred eleven eyes underwent PKP (437 patients), DALK (263 patients) and DSEK (111 patients) during the time of the study. There were eight eyes (seven patients) of developing Urrets-Zavalia syndrome during the period of the study. No eyes had a history of intraoperative mannitol injection and there was not any history of iris prolapse during the surgery. There was a history of gas injection in six of eight cases. Five of eight eyes developed Urrets-Zavalia syndrome after DALK procedure (out of 263 patients) 1 patient after DSEK and 2 patients after PKP with no statistically significant difference between three groups of patients (0.164). All of these cases in DALK method were associated with intracameral air injection.
Urrets-Zavalia syndrome could occur in all three types of keratoplasty especially in patients with intracameral gas injection. Although the incidence was low in our study (1%), it necessitates pre, intra and postoperative managements in susceptible patients.