title: Fixed dilated pupil (Urrets-Zavalia syndrome) after air/gas injection after deep lamellar keratoplasty for keratoconus.
abstract: 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.
authors.affiliation: Corneal & External Diseases Service, Moorfields Eye Hospital, London, United Kingdom. vincenzo@maurino.freeserve.co.uk
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Maurino
authors.forename: Bruce D S
authors.initials: BD
authors.lastname: Allan
authors.forename: Julian D
authors.initials: JD
authors.lastname: Stevens
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Tuft
mesh_terms: 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
chemical_list: D013459:Sulfur Hexafluoride