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BLOG: Single-pass four-throw pupilloplasty for Urrets-Zavalia syndrome
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Alberto Urrets-Zavalia first described Urrets-Zavalia syndrome in 1963 in patients with keratoconus who underwent penetrating keratoplasty. The patients developed a fixed dilated pupil after treatment with mydriatics. Since then, Urrets-Zavalia syndrome has been described after various intraocular surgeries such as deep anterior lamellar keratoplasty, Descemet’s stripping automated endothelial keratoplasty, phakic IOL placement, glaucoma surgeries and cataract removal. Postoperative rise in IOP is considered to be one of the factors responsible for fixed dilated pupils, probably due to involvement of the iris sphincter. It is also speculated that due to persistent pupil dilation the peripheral iris blocks the anterior chamber angle and leads to raised IOP.
The video here showcases a case of Urrets-Zavalia syndrome that developed after PK and cataract surgery. Pupillary stretching is performed initially to gauge the amount of iris tissue that lies beneath the PK graft, after which single-pass four-throw (SFT) pupilloplasty is performed to narrow down the pupil size and aperture. Performing this prevents postoperative glare due to persistent mydriasis, and it also helps to pull the peripheral iris that seems to occlude the anterior chamber angle. Intraoperative gonioscopy is performed to visualize the changes in the anterior chamber angle before and after SFT pupilloplasty. The preoperative raised IOP is recorded to be normal after the SFT procedure.