Urrets-Zavalia Syndrome Post Descemet Membrane Endothelial Keratoplasty (Dmek): Case Report And Review Of The Literature

Published 2025 - 43rd Congress of the ESCRS

Reference: PO522 | Type: Free paper | DOI: 10.82333/qpdh-wk87

Authors: Brendan Kyle Cummings* ¹ , Arthur Bernard Cummings ¹

¹Wellington Eye Clinic,Dublin,Ireland

Purpose

To describe a case of Urrets-Zavalia Syndrome (UZS) after Descemet membrane endothelial keratoplasty (DMEK), and review its clinical features, incidence, pathogenesis, risk factors, and management strategies.

Setting

This study was conducted at Oftalmo Center Ecuador Eye Clinic in Quito, Ecuador.

Methods

We present the case of a 53-year-old woman with corneal decompensation secondary to a phakic intraocular lens complication, who developed UZS following DMEK. In addition to describing the intraoperative and postoperative courses, we also conducted a literature review. An analysis of the published cases summarized in “Table UZS DMEK” was performed and integrated into the discussion.

Results

After an uneventful DMEK procedure, the patient experienced an early postoperative intraocular pressure (IOP) elevation of up to 37 mmHg. A reduction in the SF₆ 20% gas bubble from 80% to 50% via paracentesis was required. On postoperative day 7, a fixed, dilated pupil (initially 7 mm, later reduced to 5 mm) with posterior synechiae was observed. Six months after DMEK, the patient underwent cataract extraction with intraocular lens implantation and achieved a best-corrected visual acuity (BCVA) of 20/30 despite persistent medium mydriasis (5 mm).

Conclusions

The use of anterior chamber gas (air or SF₆ 20%) to secure the DMEK graft may lead to early postoperative ocular hypertension and subsequent UZS, especially in cases without an adequately placed inferior peripheral iridectomy (PI). Although a superior iridectomy performed during a previous phakic IOL implantation may be insufficient to prevent pupillary block, an inferior PI appears crucial for preventing UZS. Analysis of the literature reveals no clear association between the type of tamponade agent used and the development of UZS, as similar complications occur with both air and SF₆ 20%. Nonetheless, early IOP control and prophylactic inferior PI are strongly recommended.