Urrets Zavalia Syndrome

This video demonstrates the efficacy and results of performing single pass four-throw (SFT) pupilloplasty in cases of Urrets Zavalia Syndrome (UZS). UZS is a postoperative complication that was initially reported after a penetrating keratoplasty (PK) surgery characterized by fixed dilated pupil associated with iris atrophy and secondary glaucoma. The dilated pupil in UZS does not respond to pilocarpine, sympatholytic agents or to alpha-adrenergic blockers and hence the treatment is directed towards the symptomatic control of glare and photophobia with concealment of anisocoria with cosmetic contact lenses. Surgical pupilloplasty helps to alleviate the anterior chamber angle apposition in patients with UZS by mechanically pulling the peripheral iris centrally as demonstrated on AS-OCT. Intraoperative gonioscopy also demonstrates breakage of peripheral anterior synechias that leads to significant opening the anterior chamber angles.