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Case Reports
. 2024 Jan-Mar;18(1):28-30.
doi: 10.5005/jp-journals-10078-1431.

Urrets-Zavalia Syndrome of Unresolving Mydriasis Following Endocyclophotocoagulation Combined with Phacoemulsification

Anny Ms Cheng  1 , Geetha G Vedula  2 , Aarup A Kubal  2 , Jillene Moxam  3 , David Ty Yang  4 , Shailesh K Gupta  5
Affiliations
Case Reports

Urrets-Zavalia Syndrome of Unresolving Mydriasis Following Endocyclophotocoagulation Combined with Phacoemulsification

Anny Ms Cheng et al. J Curr Glaucoma Pract. 2024 Jan-Mar.

Abstract

Aim and background: Combined endocyclophotocoagulation and phacoemulsification (ECP/Phaco) are uncommonly associated with complications. We present the first case of a rare complication following ECP/Phaco.

Case description: A 72-year-old patient with dense nuclear sclerotic cataracts and primary open-angle glaucoma (POAG) underwent bilateral surgery uneventfully. He experienced a brief episode of postoperative elevated intraocular pressure (IOP), but only one eye with a lower baseline IOP developed a dilated pupil. No pupillary response was observed after applying 4% pilocarpine. The fixed mydriasis persisted without reaction to light or near stimulus, and the best-corrected vision (BCVA) was 20/30 in the affected eye.

Conclusion: This case reports a possible rare complication when undergoing ECP/Phaco therapy. The pathogenesis of Urrets-Zavalia syndrome is unknown, but we hypothesized that eyes with more pronounced increases in IOP from baseline may be more susceptible to ischemic injury to the pupillary sphincter, resulting in a chronically dilated pupil.

Clinical significance: Even a modest transient rise in postoperative IOP in a glaucomatous eye with normal baseline IOP could result in a chronically dilated pupil.

How to cite this article: Cheng AMS, Vedula GG, Kubal AA, et al. Urrets-Zavalia Syndrome of Unresolving Mydriasis Following Endocyclophotocoagulation Combined with Phacoemulsification. J Curr Glaucoma Pract 2024;18(1):28-30.

Keywords: Case report; Endocyclophotocoagulation; Microinvasive glaucoma surgery; Mydriasis; Phacoemulsification; Urrets–Zavalia syndrome.

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Conflict of interest statement

Source of support: Nil Conflict of interest: None Patient consent statement: The author(s) have obtained written informed consent from the patient for publication of the case report details and related images.

Figures

Figs 1A and B:
Figs 1A and B:
The right eye (A) shows a fixed and uniformly dilated pupil, while the left eye (B) has no evidence of pathological signs
See this image and copyright information in PMC

References

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