Abstract
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.
Highlights
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)
Other factors affecting the incidence of UZS have been identified, such as keratoconus [16,17]
Summary
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. 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. The occurrence of UZS and identifying and controlling the risk factors of UZS are more effective methods for improving patients’ quality of life. Other factors affecting the incidence of UZS have been identified, such as keratoconus [16,17]. Because the pathogenesis of UZS is unknown, the assessment and control of these related risk factors is hard to carry out
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