Fixed dilated pupil (Urrets-Zavalia syndrome) after air/gas injection after deep lamellar keratoplasty for keratoconus.
OBJECTIVE
To describe three cases of fixed dilated pupil and presumed iris ischemia (Urrets-Zavalia syndrome) after anterior chamber air/gas injection after deep lamellar keratoplasty for keratoconus.


METHODS
Interventional case series. Three eyes of three patients with keratoconus underwent deep lamellar keratoplasty and intraoperative or postoperative injection of air/gas in the anterior chamber to appose the host-donor lamellar graft interface.


RESULTS
Urrets-Zavalia syndrome was diagnosed on clinical grounds in three cases and was associated with the Descemet membrane microperforation intraoperatively and introduction of air/gas into the anterior chamber intraoperatively or postoperatively.


CONCLUSIONS
A fixed dilated pupil is an uncommon complication of penetrating keratoplasty for keratoconus that can also develop after deep lamellar keratoplasty. Leaving an air or gas bubble in the anterior chamber of a phakic eye after deep lamellar keratoplasty is a risk factor and should therefore be avoided.
Maurino
Vincenzo
V
Corneal & External Diseases Service, Moorfields Eye Hospital, London, United Kingdom. vincenzo@maurino.freeserve.co.uk
Allan
Bruce D S
BD
Stevens
Julian D
JD
Tuft
Stephen J
SJ
D000328:Adult; D000388:Air; D000867:Anterior Chamber; D001284:Atrophy; D016039:Corneal Transplantation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007267:Injections; D007498:Iris / Q000473:pathology*; D007640:Keratoconus / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015878:Mydriasis / Q000175:diagnosis / Q000209:etiology*; D013459:Sulfur Hexafluoride / Q000009:adverse effects*; D013577:Syndrome
D013459:Sulfur Hexafluoride