Dr. Devi Arun, Dr. Bhavatharini M, Dr. Rajat Kapoor
PURPOSE: To describe a case of fixed dilated pupil and presumed iris ischemia(Urrets-Zavalia syndrome) after deep lamellar keratoplasty(DALK) for keratoconus(KC)
METHODS: Interventional case study of an eye with KC which underwent uncomplicated DALK with big bubble technique.Urrets-Zavalia syndrome was diagnosed clinically and a probable mechanism secondary to acute increase in IOP and iris ischaemia was suggested
RESULTS: In our case, no Descemet membrane(DM) microperforation was noted during surgery but small air bubbles at the corneal periphery coalesced(Corneal emphysema) to form a large bubble in the interphase,pushing the DM posteriorly into the AC causing raised IOP and iris ischaemia.
CONCLUSION: A fixed dilated pupil is an uncommon complication of penetrating keratoplasty for KC that can also develop after DALK.Raised IOP causing iris sphincter ischemia,may be a probable etiology. Deflating the AC,when air is used for dissection and performing an iridotomy could be protective.