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A. M. Golden-Waddell, C. L. Springs, W. B. Lee; Urrets-Zavalia Pupil After Descemet’s Stripping Automated Endothelial Keratoplasty in Patients With Blue Irides. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2205.
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To describe several cases of classic Urrets-Zavalia pupil occurring in the post-operative period following Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK), and to classify these cases according to possible predisposing features.
A case series consisting of seven patients who underwent DSAEK and were subsequently diagnosed with Urrets-Zavalia pupil. Six cases were isolated DSAEK, while one was a combined DSAEK/cataract extraction. No cases had intraoperative complications or post-operative graft dislocation. The diagnosis of Urrets-Zavalia pupil was based on clinical examination.
The pre and post-operative patient characteristics are detailed in Table 1. All eyes underwent 100% air fill initially for one hour post-operatively, followed by release of air with 50-70% air bubble remaining. Day one IOP, any secondary intervention taken, BCVA, and length of follow up are included in Table 2.
In this series, we speculate that the presence of a blue iris, along with the use of post-operative cycloplegia, is correlated with Urrets-Zavalia syndrome in patients undergoing uncomplicated DSAEK. We hypothesize this is due to a mechanical mechanism caused by a convex partial air bubble pushing on a mid-dilated pupil, which then occludes angle structures, leading to appositional angle closure and subsequent iris ischemia. We suspect that patients with blue irides may be at increased risk of developing this complication due to the relatively sparse nature of the stroma of a lightly pigmented iris, which may not maintain its form as well as a thicker iris when cyclopleged and compressed by a surgical air bubble in the anterior chamber.
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