title: Urrets-Zavalia syndrome after Descemet membrane endothelial keratoplasty.
abstract: OBJECTIVE
  To report a case of Urrets-Zavalia syndrome (UZS) after Descemet membrane endothelial keratoplasty (DMEK).
  
  
  METHODS
  A 74-year-old woman with Fuchs endothelial dystrophy and inconspicuous ocular history developed UZS after DMEK surgery. The intraoperative and postoperative course is presented.
  
  
  RESULTS
  After uneventful DMEK surgery, intraocular pressure was elevated up to 40 mm Hg on the first postoperative day. A small bleed from the peripheral wide-open iridectomy in the 12 o'clock position in the otherwise deep anterior chamber was observed. On the sixth postoperative day, a 4-mm-wide pupil, nonreactive to light, was noted. One year after surgery, the fixed medium mydriasis (4 mm) persisted and best-corrected vision was 0.1 logMAR. No pupillary reaction was noted after application of 0.2% or 2% pilocarpine.
  
  
  CONCLUSIONS
  Filling the anterior chamber with air to secure fixation of a grafted Descemet membrane carries the risk of early acute postoperative ocular hypertension. This can lead to iris sphincter defects resulting in a fixed dilated pupil after DMEK surgery. Large patent iridectomy in the 12 o'clock position is insufficient to prevent this. Patients undergoing DMEK surgery should be informed about this potential complication.
authors.affiliation: University Eye Hospital Düsseldorf, Düsseldorf NRW - Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Holtmann
authors.forename: Kristina
authors.initials: K
authors.lastname: Spaniol
authors.forename: Gerd
authors.initials: G
authors.lastname: Geerling
mesh_terms: D000086:Acetazolamide / Q000627:therapeutic use; D000368:Aged; D002387:Cataract Extraction; D003131:Combined Modality Therapy; D057111:Descemet Stripping Endothelial Keratoplasty / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007429:Intraocular Pressure; D032801:Iridectomy; D007498:Iris / Q000601:surgery; D015878:Mydriasis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D009798:Ocular Hypertension / Q000209:etiology; D064727:Posterior Capsulotomy; D011184:Postoperative Period; D014792:Visual Acuity / Q000502:physiology
chemical_list: D005938:Glucocorticoids; D000086:Acetazolamide