Urrets-Zavalia syndrome after deep anterior lamellar keratoplasty

Abstract

Introduction. Urrets-Zavalia syndrome is an uncommon complication of the deep anterior lamellar keratoplasty in keratoconus. The manifestations of this syndrome are an irreversible mydriasis, iris atrophy and secondary glaucoma. Case report. Deep anterior lamellar keratoplasty was done for keratoconus with a presumably healed corneal hydrops in a 21-year-old Caucasian man. The graft remained clear, but the surgery was complicated by a fixed, dilated pupil, patches of iris atrophy, ectropium of the iris pigment layer and glaukomflecken in the lens. Conclusion. Although safer than penetrating keratoplasty, the deep anterior lamellar corneal transplantation is not devoid of complications. Urrets-Zavalia syndrome can be avoided by not trying to secure an unhealed Descemet's membrane with air. Instead, a new Descemet's membrane transplanted within a penetrating graft is a safer choice.

Uvod. Sindrom Urets-Zavalije je neuobičajena komplikacija posle operacije keratokonusa metodom duboke prednje lamelarne keratoplastike. Manifestacije ovog sindroma su trajna midrijaza, atrofija dužice i sekundarni glaukom. Prikaz bolesnika. Kod bolesnika starog 21 godinu, urađena je duboka prednja lamelarna keratoplastika sa keratokonusom i naizgled zaceljenim hidropsom rožnjače. Kalem je ostao providan, ali se operacija komplikovala trajnom midrijazom, poljima atrofije dužice, izvrnutim rubom pigmentnog sloja dužice i mrljastim zamućenjima ispod prednje kapsule sočiva (glaukomflecken). Zaključak. Mada bezbednija od perforativne keratoplastike, duboka prednja lamelarna transplantacija rožnjače nije bez komplikacija. Sindrom Urets-Zavalije može se izbeći ako se umesto zaptivanja otvora u Descemetovoj membrani pomoću vazduha, presadi nova Descemetova membrana zajedno sa kalemom, tehnikom perforativne keratoplastike.