SECONDARY ANGLE-CLOSURE GLAUCOMA IN THE COURSE OF URRETS-ZAVALIA SYNDROME: APPLICATION OF ADVANCED DIAGNOSTIC AND SURGICAL TECHNIQUES
Published 2025 - 29th ESCRS Winter Meeting
Reference: PO147 | Type: Free Paper | DOI: 10.82333/049a-hr98
Authors: Dominik Dygas* 1 , Julia Janiszewska-Salamon 1 , Wojciech Maruszczyk 2 , Paulina Langosz 2 , Krzysztof Eder 1 , Mariola Dorecka 1 , Adrian Smędowski 3 , Ewa Mrukwa-Kominek 1 , Dorota Wyględowska-Promieńska 1
1Department of Ophthalmology,Prof. K. Gibinski University Clinical Center, Medical University of Silesia in Katowice,Katowice,Poland;Department of Ophthalmology,Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice,Katowice,Poland, 2Department of Ophthalmology,Prof. K. Gibinski University Clinical Center, Medical University of Silesia in Katowice,Katowice,Poland, 3Department of Ophthalmology,Prof. K. Gibinski University Clinical Center, Medical University of Silesia in Katowice,Katowice,Poland;Department of Ophthalmology,Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice,Katowice,Poland;GlaucoTech Sp. z o.o.,Katowice,Poland
Purpose
Urrets-Zavalia syndrome is described as a postoperative ophthalmologic complication characterized by persistent pupil dilation associated with iris atrophy and secondary glaucoma. The first reported case involved pupil dilation following a penetrating keratoplasty in a patient with keratoconus. Common risk factors for this syndrome include elevated intraocular pressure (IOP), phakia, and the presence of air or gas in the anterior chamber. The objective of this report is to present a case study of a female patient who developed Urreta-Zavalia syndrome complicated by drug-resistant secondary glaucoma following phacoemulsification cataract surgery with intraocular lens implantation.
Setting
Department of Ophthalmology, Prof. K. Gibinski University Clinical Center, Medical University of Silesia in Katowice
Methods
Case report: A 47-year-old female presented to the Emergency Department with elevated IOP in the left eye. Her medical history included an uncomplicated left-eye cataract extraction performed three months prior. Postoperatively, the patient experienced pupil dilation with a secondary rise in IOP and corneal decompensation. She was prescribed three topical IOP-lowering agents and oral acetazolamide. Examination of the left eye revealed BCVA of 0.5/50, IOP of 42 mmHg, corneal edema, near-complete circular anterior synechiae, and a wide, fixed pupil. There was no response to pilocarpine drops.
Results
After additional investigations, trabeculectomy was deemed too high-risk, and the patient was instead scheduled for XEN gel stent implantation via ab externo approach. The procedure was completed without complications, with the assistance of intraoperative OCT. On the first postoperative day, the left eye's IOP was 4 mmHg. During the nine-month follow-up period, IOP remained within normal limits.
Conclusion
Urrets-Zavalia syndrome is a rare complication of cataract surgery. The resulting changes in the anterior segment complicate glaucoma surgeries, necessitating innovative and unconventional surgical approaches.