Unilateral Urrets-Zavalia syndrome after Implantable Collamer Lens implantation: a case report and review of the literature

Abstract Background Fixed dilated pupil after ophthalmic surgery or Urrets-Zavalia syndrome occurs after anterior segment surgery and usually relates to postoperative elevation of intraocular pressure. Urrets-Zavalia syndrome results in complaints of glare, halo, and photophobia. Retention of the viscoelastic agent during Implantable Collamer Lens implantation can result in postoperative elevation of intraocular pressure and Urrets-Zavalia syndrome. However, reversibility of pupillary dilatation is possible in some cases. Case presentation A 20-year-old Thai man with myopic astigmatism in both eyes underwent Implantable Collamer Lens implantation in the right eye. The preoperative slit-lamp examination of both eyes was normal, and no ectatic changes were detected from corneal tomography. One hour after the uncomplicated surgery of the right eye, intraocular pressure increased to 48 mmHg and was immediately controlled with antiglaucoma medications. Postoperative pupillary dilatation was detected, presumably due to effect of preoperative application of mydriatic drops. At postoperative day 1, the right pupil remained dilated but still reactive to light and pilocarpine 2% eye drops. Two weeks later, the left eye underwent the Implantable Collamer Lens implantation and showed neither postoperative increase in intraocular pressure nor postoperative pupillary dilatation. Two months after surgery, the dilatation of the right pupil partially reversed. Conclusions The findings of the right eye suggested diagnosis of Urrets-Zavalia syndrome. Compared with former reports, we noted an association between immediate control of elevation of postoperative intraocular pressure, light reactivity of the dilated pupil, and reactivity to pilocarpine 2% eye drops as potential predictors for reversibility of Urrets-Zavalia syndrome.

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Urrets-Zavalia Syndrome Following Cataract Surgery

Case Reports in Ophthalmology ◽

10.1159/000513959 ◽

2021 ◽

pp. 659-663

Author(s):

Shimon Kurtz ◽

Maayan Fradkin

Keyword(s):

Intraocular Pressure ◽

Case Report ◽

Cataract Surgery ◽

Anterior Chamber ◽

Inflammatory Reaction ◽

Intraocular Lens Implantation ◽

Postoperative Course ◽

Lens Implantation ◽

The Right

We describe a case of Urrets-Zavalia syndrome (UZS) in a healthy 56-year-old woman who underwent femtosecond-assisted phacoemulsification with intraocular lens implantation in both eyes. One month after an uneventful postoperative course in the left eye, the right eye was operated. Dilated pupil which was nonreactive to light appeared on day 21 postoperatively. This was discovered upon examination following anterior chamber inflammatory reaction which occurred 2 weeks following her surgery. Our case report emphasizes the importance and danger in developing UZS even if the reaction in the anterior chamber does not occur immediately after surgery. In addition, the importance of intraocular pressure follow-up in the period after UZS is acknowledged.

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Use of micropulse trans-scleral cyclophotocoagulation for acute rise in intraocular pressure due to anterior segment inflammation

European Journal of Ophthalmology ◽

10.1177/1120672120924341 ◽

2020 ◽

pp. 112067212092434

Author(s):

Shotaro Asano ◽

Victor Koh Teck Chang ◽

Maria Cecilia Domingo Aquino ◽

Paul Chew Tec Kuan

Keyword(s):

Intraocular Pressure ◽

Rescue Therapy ◽

Anterior Segment ◽

Poor Response ◽

Posterior Capsular Opacification ◽

Nd:Yag Laser Capsulotomy ◽

Pressure Spike ◽

History Of ◽

The Right ◽

Rescue Procedure

Purpose The aim of this study was to report the use of micropulse trans-scleral cyclophotocoagulation as an adjunct therapy for two cases of medically uncontrolled intraocular pressure spikes due to anterior segment inflammation. Case description: Case 1 had previous cataract surgery and exhibited an intraocular pressure spike due to phacoantigenic uveitis (right eye intraocular pressure = 52 mmHg). Despite medical treatment, the right eye intraocular pressure remained high (43 mmHg), thus micropulse trans-scleral cyclophotocoagulation was carried out as a rescue therapy. After micropulse trans-scleral cyclophotocoagulation, the intraocular pressure at 1 day and 3 weeks was 9 and 16 mmHg, respectively. Case 2 had a history of previous blunt ocular trauma and 180° of angle recession. Both eyes were pseudophakia and underwent right eye Nd:YAG laser capsulotomy for posterior capsular opacification. Immediately after the procedure, the right eye intraocular pressure increased to 64 mmHg. Due to poor response to medical therapy, rescue micropulse trans-scleral cyclophotocoagulation was performed. After micropulse trans-scleral cyclophotocoagulation, the intraocular pressure at 1 day and 2 months was 12 and 21 mmHg, respectively. Conclusion Micropulse trans-scleral cyclophotocoagulation successfully decreased intraocular pressure in both cases of acute rise in intraocular pressure. Micropulse trans-scleral cyclophotocoagulation can potentially be useful as a rescue procedure to safely reduce medically uncontrollable intraocular pressure spike due to anterior segment inflammation.

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Posterior-Chamber Phakic Intraocular Lens Implantation in Patients over 40 Years of Age

Journal of Ophthalmology ◽

10.1155/2020/7457902 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Pedro Tañá-Rivero ◽

Francisco Pastor-Pascual ◽

Marceliano Crespo ◽

José L. Rodríguez-Prats ◽

José J. Muñoz-Tomás ◽

...

Keyword(s):

Crystalline Lens ◽

Posterior Chamber ◽

Spherical Equivalent ◽

Efficacy And Safety ◽

Phakic Intraocular Lens ◽

Implantable Collamer Lens ◽

Lens Implantation ◽

Over 40 Years ◽

Myopic Astigmatism

Purpose. To assess the efficacy, safety, and predictability of the Visian Implantable Collamer Lens (ICL) model having a central port in patients over 40 years of age. Methods. This study included 33 eyes from 21 patients who underwent V4c ICL implantation for the correction of myopia and myopic astigmatism. We assessed uncorrected (UDVA) and corrected (CDVA) distance visual acuity, refraction, intraocular pressure (IOP), endothelial cell density (ECD), vault, and adverse events occurring over a 1-year period. Results. Mean age of the patients at the time of implantation was 43.52 ± 4.49 years (range: 40 to 56 years). Efficacy and safety indexes were 1 and 1.09, respectively. Surgical outcomes for CDVA were as follows: no eye lost any lines, 19 eyes (57.58%) showed no CDVA changes, 7 eyes (21.21%) gained 1 line, 4 eyes (12.12%) gained 2 lines, and 3 eyes (9.09%) gained ≥3 lines. Mean postoperative spherical equivalent (SE) was −0.09 ± 0.47 D. A total of 29 eyes (87.8%) were within ±0.50 D and 31 eyes (93.9%) were within ±1.00 D of the desired SE. At 1-year, mean IOP was 15.27 ± 3.03 mmHg (range: 9 to 20 mmHg, p=0.12 pre vs. post) and mean ECD was 2516 ± 234 cells/mm2 (p=0.29 pre vs. post). Mean postoperative vault was 320 ± 136 μm, with 201–300 μm being the most prevalent vault range for 9 eyes (31.03%). None of the eyes showed a vault >701 μm. There were neither intraoperative nor postoperative complications; in fact, all ICL implantation procedures were uneventful. Conclusions. Our study’s findings support the use of this lens in patients over 40 years of age. A long follow-up period is advisable to monitor ICL position relative to the crystalline lens.

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The changes of anatomic and topographic characteristics of eye anterior segment after uncomplicated cataract phacoemulsification

Kazan medical journal ◽

10.17816/kmj1805 ◽

2013 ◽

Vol 94 (6) ◽

pp. 853-858

Author(s):

A A Ryabtseva ◽

M P Yugaj ◽

N S Nikitina

Keyword(s):

Intraocular Pressure ◽

Anterior Chamber ◽

Anterior Segment ◽

Anterior Chamber Depth ◽

Ultrasound Biomicroscopy ◽

Anterior Chamber Angle ◽

Ciliary Processes ◽

Lens Implantation ◽

Topographic Characteristics ◽

Chamber Angle

Aim. To study the changes of anatomic and topographic characteristics of the eye anterior segment after uncomplicated cataract phacoemulsification using corneal incision with intraocular soft lens implantation. Methods. The data of ultrasound biomicroscopy and noncontact tonometry of 58 eyes (56 patients, 32 females, 24 males aged 54 to 78 years) before and after cataract phacoemulsification were analyzed. Paitents with survived ocular trauma, refractive keratoplasty, glaucoma, uveitis, and surgical complications (incomplete capsulorrhexis, posterior capsule rupture, ciliary zonule disinsertion, corneal burn). Apart from the common examinations (visual acuity testing, tonometry, tonography, eye A- and B-ultrasonography, biomicroscopy), all patients underwent eye ultrasound biomicroscopy. Results. Anterior chamber depth increased from 2.73±0.10 to 4.17±0.06 mm (p ≤0.001). Trabecula-iris distance measured at 500 μm from the scleral spur, increased from 0.38±0.02 to 0.47±0.02 mm (p ≤0.001). Anterior chamber angle increased from 28.69±1.87 to 42.73±1.56 degrees (p ≤0.001), the angle between the iris and the sclera increased from 32.78±1.39 to 41.36±0.84 degrees (p ≤0.001), the angle between the sclera and ciliary processes increased from 39.48±1.29 to 45.30±1.16 degrees (p ≤0.001). Intraocular pressure according to the non-contact tonometry data decreased from 18.16±1.29 to 13.55±0.95 mm Hg (p ≤0.001). Conclusion. Anterior chamber depth, trabecula-iris distance, anterior chamber angle, the angle between sclera and iris and the angle between sclera and ciliary processes increased significantly after phacoemulsification with intraocular lens implantation. Intraocular pressure decreased significantly according to the non-contact tonometry data.

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A Case Study on Retinoblastoma Associated Orbital Cellulitis

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i130799 ◽

2021 ◽

pp. 91-97

Author(s):

Sagili Chandrasekhara Reddy ◽

Bina Sharine Menon

Keyword(s):

Anterior Segment ◽

Oral Prednisolone ◽

Detailed Examination ◽

Orbital Cellulitis ◽

Eye Drops ◽

Upper Eyelid ◽

Bilateral Retinoblastoma ◽

Pediatric Oncologist ◽

The Right

A 20-months-old male child was brought to the Eye clinic with swelling of right upper eyelid, discharge sticking the eyelids in the right eye and redness in both eyes of three days duration. On detailed examination of anterior segment and fundus, the diagnosis of bilateral retinoblastoma with conjunctivitis was made. The conjunctivitis was cured with ciprofloxacin eye drops and eye ointment. CT scan of orbits and brain confirmed the diagnosis of retinoblastoma with calcification in both eyes. Optic nerve on both sides was normal and there was no metastasis in the brain. Since it was a bilateral case of retinoblastoma, chemoreduction followed by enucleation in the right eye, and salvaging the left eye with chemotherapy in order to save the vision was planned. Intravenous triple drug chemotherapy with carboplatin, etoposide and vincristine (six cycles) was started by pediatric oncologist in pediatric ward. After two weeks of completing the first cycle of treatment, enucleation of right eye was done. Postoperative period was uneventful. The chemotherapy was continued. The child developed marked swelling of left upper eyelid few days before the sixth cycle of chemotherapy. Examination of left eye showed signs of aseptic orbital cellulitis which was treated with oral prednisolone and topical eye drops of combination of gentamycin and dexamethasone. The inflammatory signs subsided completely in ten days time. The sixth cycle of chemotherapy was completed. On the follow up visit two weeks after discharge, the left eye ball was normal. In the first follow up, the child could pick up the toys thrown in front of him. Unfortunately the child defaulted follow up. Retinoblastoma should be excluded in all young children with orbital cellulitis because misdiagnosis is life threatening.

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Ocular Surface Changes Associated with Ophthalmic Surgery

Journal of Clinical Medicine ◽

10.3390/jcm10081642 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1642

Author(s):

Lina Mikalauskiene ◽

Andrzej Grzybowski ◽

Reda Zemaitiene

Keyword(s):

Dry Eye ◽

Ocular Surface ◽

Anterior Segment ◽

Dry Eye Disease ◽

Postoperative Treatment ◽

Eye Disease ◽

Ophthalmic Surgery ◽

Patient’S Satisfaction ◽

The Impact ◽

Anterior Segment Surgery

Dry eye disease causes ocular discomfort and visual disturbances. Older adults are at a higher risk of developing dry eye disease as well as needing for ophthalmic surgery. Anterior segment surgery may induce or worsen existing dry eye symptoms usually for a short-term period. Despite good visual outcomes, ocular surface dysfunction can significantly affect quality of life and, therefore, lower a patient’s satisfaction with ophthalmic surgery. Preoperative dry eye disease, factors during surgery and postoperative treatment may all contribute to ocular surface dysfunction and its severity. We reviewed relevant articles from 2010 through to 2021 using keywords “cataract surgery”, ”phacoemulsification”, ”refractive surgery”, ”trabeculectomy”, ”vitrectomy” in combination with ”ocular surface dysfunction”, “dry eye disease”, and analyzed studies on dry eye disease pathophysiology and the impact of anterior segment surgery on the ocular surface.

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Implantation of a trifocal toric intraocular lens to a patient with pigment dispersion syndrome

Kazan medical journal ◽

10.17816/kmj2019-495 ◽

2019 ◽

Vol 100 (3) ◽

pp. 495-499

Author(s):

R F Akhmetshin ◽

M R Gilyazev ◽

A T Galeeva ◽

S N Bulgar

Keyword(s):

Intraocular Pressure ◽

Intraocular Lens ◽

Anterior Segment ◽

Ultrasound Biomicroscopy ◽

Pigment Dispersion ◽

Toric Intraocular Lens ◽

Lens Extraction ◽

Pigment Dispersion Syndrome ◽

Myopic Astigmatism ◽

Peripheral Iridotomy

Aim. To present a clinical case of treatment of pigment dispersion syndrome by clear lens extraction and implantation of a toric intraocular lens in a patient with myopic astigmatism. Methods. A 33-year-old patient with a diagnosis of moderate myopia, complex mild myopic astigmatism, pigment dispersion syndrome of both eyes. Results. The first stage was laser peripheral iridotomy of both eyes. On follow-up pathological irido-zonular contact and increases intraocular pressure by 2 mm persisted. The second stage included clear lens extraction and implantation of a toric multifocal intraocular lens to both eyes. In 2 months, distance and near visual acuity was 1.0, intraocular pressure was normal, no pathological irido-zonular contact was observed according to the ultrasound biomicroscopy. Conclusion. Implantation of an intraocular lens in patients with myopia and pigment dispersion syndrome is both a method of preventing pigment glaucoma and myopia correction; patients with pigment dispersion syndrome after peripheral iridotomy should monitor the state of the anterior segment of the eye and the effectiveness of the treatment by ultrasound biomicroscopy.

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Chorioretinal Folds in the Trabeculectomized Eye with Normal Intraocular Pressure after Phacoemulsification

Medicina ◽

10.3390/medicina57090896 ◽

2021 ◽

Vol 57 (9) ◽

pp. 896

Author(s):

Yi-Fen Lai ◽

Ching-Long Chen ◽

Ke-Hao Huang ◽

Yi-Hao Chen

Keyword(s):

Intraocular Pressure ◽

Case Report ◽

Visual Loss ◽

Early Recognition ◽

Open Angle Glaucoma ◽

Eye Drops ◽

Fundus Examination ◽

Blurred Vision ◽

Foveal Thickness ◽

The Right

Background and Objectives: This case report discusses possible causes of chorioretinal fold (CRF) formation. Materials and Methods: A case report. Results: A 48-year-old man presented with a history of high myopia and primary open-angle glaucoma in both eyes. He underwent a trabeculectomy followed by phacoemulsification in both eyes. Two months later, he complained of blurred vision in the right eye. The intraocular pressure (IOP) was 17 mmHg in the left eye and 9 mmHg in the right eye. Refraction showed a hyperopic shift in both eyes. Slit-lamp examination showed a deep anterior chamber without cells and a well-functional bleb without leakage. Fundus examination revealed CRFs in the macula of the right eye. No papilledema, choroidal lesions, or other retinal lesions were found. Wrinkling of CRFs at the macula, an increase in central foveal thickness, and a fluid cleft were demonstrated by spectral-domain optical coherence tomography. After using steroid eye drops, the IOP in the right eye and refraction in both eyes recovered to the baseline level. Visual acuity improved in both eyes. Conclusions: CRFs in trabeculectomized eyes with normal IOP after phacoemulsification have not been reported. This case demonstrated that the trabeculectomized eye remains at risk of CRF formation, even if the IOP is normal without hypotony. The importance of a detailed fundus examination in patients with unexplained blurred vision may be necessary after having undergone these procedures. The early recognition of the cause of visual loss may facilitate immediate treatment and may avoid irreversible changes with permanent visual loss.

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