Urrets-Zavalia Syndrome Following Cataract Surgery.

To report a patient with right eye Urrets-Zavalia syndrome following uncomplicated cataract surgery, as well as his medical and surgical management.

Ophthalmology department, Hospital Universitario de Navarra (Iruña/Pamplona, Spain).

An observational case report of a 76-year-old woman with a five-day right-eye blurry vision and photophobia following cataract surgery 2 weeks earlier. No previous ocular pathology. The patient underwent a complete ophthalmic examination, including anterior segment images, anterior segment optical coherence tomography (AS-OCT) and intraoperative images. Right eye 20/30 pinhole visual acuity. Transparent cornea. Anterior chamber (AC) Van-Herick grade IV. Pigmented Tyndall. Stromal patchy diffuse iris transillumination. Medium-sized unreactive mydriasis. Pseudophakia inside capsular bag. Right eye 26 mmHg intraocular pressure (IOP). Normal fundus. Gonioscopy depicts a 360º Shaffer IV grade angle associated with inferior pigmented trabecular meshwork and retro-inserted ciliary band. No history of previous ocular blunt trauma. Proper AS-OCT, not showing any angular or lens alterations. Non-prostaglandin hypotensive drugs and topical steroid were initiated, improving IOP and inflammation. Endophthalmitis, UGH syndrome, residual crystalline fragments, BADI-BATI syndrome and/or herpetic involvement were ruled out, leading to a Urrets-Zavalia syndrome diagnosis of exclusion. Due to the mydriasis ocular discomfort, a pupilloplasty was performed, with a suitable recovery and a pleasant subjective visual perception. The IOP manteins stable with medication, preventing from a glaucomatous optic nerve damage.

Urrets-Zavalia syndrome is a rare postoperative complication characterized by a fixed dilated pupil associated with stromal iris atrophy, initially reported after penetrating keratoplasty. The etiological mechanisms are not fully understood, but there are related with an increase in peri-procedure intraocular pressure that induces iris ischemia with AC pigmented-cells discharge. Pupil surgical closure is suggested in reiterated binocular visual annoyance. The main long-term complication is the development of pigmentary glaucoma.