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

Anny MS Cheng; Geetha G Vedula; Aarup A Kubal; Jillene Moxam; David TY Yang; Shailesh K Gupta

doi:10.5005/jp-journals-10078-1431

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

Anny MS Cheng, Geetha G Vedula, Aarup A Kubal, Jillene Moxam, David TY Yang, Shailesh K Gupta

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

Citation Information : Cheng AM, Vedula GG, Kubal AA, Moxam J, Yang DT, Gupta SK. Urrets–Zavalia Syndrome of Unresolving Mydriasis Following Endocyclophotocoagulation Combined with Phacoemulsification. J Curr Glaucoma Pract 2024; 18 (1):28-30.

DOI: 10.5005/jp-journals-10078-1431

License: CC BY-NC 4.0

Published Online: 30-03-2024

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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.

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