Urrets-Zavalia Syndrome Following Triple Ophthalmic Procedure: Case Report

Post-surgical persistent mydriasis, or Urrets-Zavalia syndrome, is a complication with significant clinical consequence, characterized by fixed pupillary dilation. The syndrome's pathogenesis is linked to transient intraocular pressure spikes. Although described initially in the context of penetrating keratoplasty, its occurrence has been documented following a diverse array of intraocular interventions. This case provide a valuable learning resource for the scientific community and can indicate areas of interest for future research.

We present the case of a 68-year-old female patient with monophthalmia of the left eye. The right eye exhibited a dense (brown) cataract associated with a full-thickness corneal stromal scar, resulting in visual acuity reduced to light perception. 

The patient underwent a triple surgical procedure comprising penetrating keratoplasty, open-sky cataract surgery, and implantation of a monofocal intraocular lens within the capsular bag. At the 7-day post-operative follow-up consultation, semi-mydriasis and ocular hypertension, measured at 42 mmHg, were observed. A diagnosis of Urrets-Zavalia syndrome was established. The patient was managed with systemic and topical hypotensive agents. Subsequent clinical follow-up demonstrated resolution of the ocular hypertension, but persistent semi-mydriasis was noted.

In conclusion, this case report contributes to the body of documented instances of Urrets-Zavalia syndrome following complex surgical interventions, thereby enhancing our understanding of this clinical entity. Timely detection and intervention are paramount in mitigating the potential, and occasionally irreversible, sequelae on visual function.