Objective: To report on 8 patients who developed prolonged mydriasis after argon laser peripheral iridoplasty (ALPI). Design: Retrospective case series. Methods: A review of the charts of 8 patients with persistent occludable angles after laser iridotomy who developed mydriasis after undergoing ALPI. Results: 12 eyes of 8 patients (mean age 50.2, standard deviation 6.9, range 40–61 years) developed persistent dilatation. 7 of 8 patients had plateau iris syndrome. Only one patient had a decrease in visual acuity. Intraocular pressure increased only in 1 eye and remained stable or decreased in the others. Of the 8 patients, 7 had blurred vision, 2 had photophobia, 4 had glare and 1 had discomfort. The pupillary response to pilocarpine instillation was minimal or absent. Mydriasis eventually resolved in all eyes without treatment. Conclusion: ALPI can be complicated by mydriasis unresponsive to pilocarpine. Mydriasis and accompanying symptoms resolved spontaneously within 1 year in most patients.

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Urrets-Zavalia syndrome as a complication of argon laser peripheral iridoplasty

A 26-year-old man with degenerative high myopia had bilateral anterior chamber phakic intraocular lens (IOL) implantation under general anesthesia The preoperative slitlamp examination was normal No mydriatic drops were used before, during, or after the procedure Postoperatively, the intraocular pressure (IOP) in the right globe increased to 60 mm Hg After the IOP was controlled, the pupil became fixed and dilated Iris fluorescein angiography was obtained and delayed filling of the iris capillary plexus with large areas of no perfusion was observed in the right eye Based on these findings, a diagnosis of Urrets-Zavalia syndrome was made To our knowledge, this is the first report of Urrets-Zavalia syndrome after phakic IOL implantation

Fixed, dilated pupil after phakic intraocular lens implantation

Background The aims of this study were to evaluate visual function outcomes in idiopathic intracranial hypertension (IIH) patients who underwent ventriculoperitoneal (VP) shunt for visual loss and to determine a VP shunt survival curve over time. Methods A retrospective medical record review was performed of all new IIH patients first evaluated at our institution who underwent VP shunt placement over a 7-year period (2004-2010). There were 2 primary outcome measures: the first being visual acuity (VA) and the second being shunt survival. Patients who received VP shunt for visual loss were included in the visual outcome analysis, and all patients who received VP shunt for any reason were included in the shunt survival analysis. Results Of the 338 new patients with IIH, 19 patients (6%) met the inclusion criteria and 17 underwent VP shunt for visual loss and 2 for headaches. Average follow-up was 21.2 months (range, 5-1,342 days). Of the 17 patients who had VP shunt for visual loss, 5 patients had optic nerve sheath fenestration (ONSF) surgery before VP shunt, and 1 patient had bilateral ONSF surgery after VP shunt. Median VA before shunt was 20/200 in the worse eye (range, 20/20 to NLP) and 20/40 in the better eye (20/20 to HM). Median VA after shunt was 20/60 in the worse eye (20/20 to lumboperitoneal) and 20/30 in the better eye (20/20 to 20/800). The improvement in VA was statistically significant in both worse eyes (P = 0.002, Wilcoxon signed-rank test) and better eyes (P = 0.028). The mean automated visual field (AVF) mean deviation (MD) of available AVFs before shunt was 223.36 dB (range, 233.38 to 27.01 dB) for the worse eye (n = 11) and 219.66 dB (230.11 to 25.91 dB) for the better eye (n = 11). Mean AVF MD deviation of available AVFs after shunt was 220.68 dB (232.13 to 23.97 dB) for the worse eye (n = 11) and 216.35 dB (232.13 to 21.00 dB) for the better eye (n = 11): this improvement was not significant (P = 0.27, P = 0.26, respectively). Independent masked record reviews by 3 neuro-ophthalmologists showed that 9 (53%) patients improved, 5 (29%) unchanged, 1 (6%) worsened, and 2 (12%) were indeterminate. Kaplan-Meier analysis showed a persistent steady decrease of functioning VP shunts over the entire period of 36 months with 80%, 65%, and 48% of VP shunts functioning without replacement, removal, or revision at 12, 24, and 36 months, respectively. Conclusion VP shunts improve or stabilize most IIH patients presenting with severe progressive visual loss or those with visual loss refractive to medical treatment and ONSF. Survival analysis shows persistent decrease of functioning shunts over time.

Ventriculoperitoneal shunt as a treatment of visual loss in idiopathic intracranial hypertension

Urrets-Zavalia syndrome (fixed and dilated pupil following penetrating keratoplasty for keratoconus) and its variants

PURPOSE To report a fixed dilated pupil and anterior subcapsular cataract formation following Descemet stripping endothelial keratoplasty (DSAEK). METHODS A 47-year-old man with Fuchs endothelial dystrophy underwent DSAEK of the right eye. The preoperative slit lamp examination was normal. Mydriatic drops were used at the end of procedure. RESULTS Postoperatively, the pupil remained fixed and dilated with no right direct or consensual response to light, or constriction during accommodation throughout a 1-year follow-up period. Slit lamp examination after air resorption revealed a transient anterior subcapsular cataract and posterior synechiae. Based on these findings, a diagnosis of Urrets-Zavalia syndrome was made. CONCLUSION To our knowledge, this is the first report of Urrets-Zavalia syndrome after DSAEK.

Fixed dilated pupil (urrets-zavalia syndrome) and anterior subcapsular cataract formation after descemet stripping endothelial keratoplasty.

Editor,—A fixed and dilated pupil is an uncommon postoperative complication first described by Urrets-Zavalia following penetrating keratoplasty for keratoconus1 We report the same problem occurring in two patients after uncomplicated trabeculectomy To the best of our knowledge, such cases have not been previously described in the literature

### CASE 1

A 38 year old woman with bilateral advanced glaucoma was referred for further management of her condition Her ophthalmic history included surgery to her left squint as a child and left amblyopia She was otherwise fit and well and took no systemic medication

On examination her best corrected visual acuities were 6/6 in the right eye and 6/36 in the left with a left relative afferent pupillary defect Her anterior segments were normal and her intraocular pressure (IOP) was 19 mm Hg bilaterally on timoptol twice daily Gonioscopy revealed open angles and funduscopy showed …

https://bjo.bmj.com/content/bjophthalmol/84/3/337.3.full.pdf

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Urrets-Zavalia syndrome following trabeculectomy