Update and review of Urrets-Zavalia syndrome.

Otavio A Magalhães,Carina T Sanvicente,Eduardo G Müller,Claudia L Kronbauer

doi:10.5935/0004-2749.20160059

Abstract

For more than half a century, Urrets-Zavalia syndrome (fixed dilated pupil) has been described as a postoperative complication of ophthalmic surgery. Since first reported as a complication of penetrating keratoplasty for keratoconus in patients receiving atropine, the characteristic features of Urrets-Zavalia syndrome have been expanded. In previous literature, a total of 110 cases resulted in a fixed and dilated pupil. Increased intraocular pressure (IOP) in the immediate postoperative period, phakia, and air or gas in the anterior chamber appear to be the most important risk factors for Urrets-Zavalia syndrome following ophthalmic procedures. Mannitol, IOP control, the removal of air or gas in the anterior chamber, and iridectomy have all demonstrated utility in managing Urrets-Zavalia syndrome.

Highlights

Urrets-Zavalia syndrome (UZS; fixed dilated pupil) was first recogni zed by Castroviejo and published in 1963 by Alberto Urrets-Zavalia Jr., who described six cases of atrophic and mydriatic pupil associated with secondary glaucoma following penetrating keratoplasty (PK) in patients with keratoconus[1,2]
Other procedures shown to be associated with UZS include trabeculectomy (TREC)(5), deep anterior lamellar keratoplasty (DALK)(12-15), Descemet-stripping automated endothelial keratoplasty (DSAEK)(16-18), cataract surgery[11,19], goniotomy[20], phakic intraocular lens implant (IOL)(21-23), argon laser peripheral iridoplasty (ALPI)(7), and octafluoropropane injection (C3F8)(24)
The purpose of the present review is to identify all reported cases of UZS published prior to December, 2014 in Medline and EMBASE databases, highlight the most prevalent risk factors, and describe measures for the prevention of Urrets-Zavalia syndrome

Summary

Introduction

Urrets-Zavalia syndrome (UZS; fixed dilated pupil) was first recogni zed by Castroviejo and published in 1963 by Alberto Urrets-Zavalia Jr., who described six cases of atrophic and mydriatic pupil associated with secondary glaucoma following penetrating keratoplasty (PK) in patients with keratoconus[1,2]. The reported incidence of UZS is low, the associated visual symptoms can cause limitations in activities of daily life requiring preventative measures by ophthalmic surgeons[7,14]. The purpose of the present review is to identify all reported cases of UZS published prior to December, 2014 in Medline and EMBASE databases, highlight the most prevalent risk factors, and describe measures for the prevention of Urrets-Zavalia syndrome

Objectives

Findings

Discussion

Conclusion