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A case of Urretz-Zavala Syndrome following DSAEK surgery.

Poster Details

First Author: J.Esteves D. P. Leandro -0

Co Author(s):                  

Abstract Details


To report a case of DSAEK for corneal edema secondary to Fuchs dystrophy who developed a permanently and irreversible dilated pupil with iris atrophy.


Ophthalmology Department, São João Hospital Center - Oporto, Portugal


A 53-year-old man was referred to our Cornea Department for a corneal central edema in his left eye due to Fuchs Endotelial dystrophy. He underwent a Descemet's stripping automated endothelial keratoplasty (DSAEK) for that reason. His medical history was unremarkable. Preoperatively, the intraocular pressure in OE was 12mmhg. The slit-lamp exam showed central cornea edema and nuclear cataract. The corneal thickness measured was 648um. A 8mm wide and 200um thick posterior corneal lamellae of the donor was introduced in the recipient's anterior chamber. A SF6 at 50% air bubble was delivered to the eye at the end of the procedure. In the 5 th day pos-op, the Descemet lamella was slightly decentered, with superior corneal edema. The pupil was noted to be semi dilated with an intraocular pressure of 13 mm Hg. During the following weeks the IOP measurements were normal and the iris has remained fixed, dilated, and non-reactive. A superior anterior sinechia was present. Six months postoperatively the visual acuity was 35/20 with +0.75 +3.00 x 90º, with small superior corneal edema, deep and quiet anterior chamber and fixed dilated pupil with an accompanying area of iris atrophy. The patient had glare related complaints.


Although he UZ syndrome was first described in keratoconus patients submitted to Penetrating Keratoplasty, it has also been observed after lamellar procedures such as DSAEK. The etiology might be related to pupillary block caused by the air bubble used during the procedure. In this case the iris was fixed with areas of atrophy. This uncommon complication presented without the use of mydriatic drops and no postoperative pressure rises or anterior chamber reaction.



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