The authors have no financial interest in the subject matter of this e-poster M. K. Kummelil, S. Nagappa, A. Shetty Cataract and Refractive Surgery Services, Narayana Nethralaya, Post-Graduate Institute of Ophthalmology Bangalore, India. Urrets-Zavalia Syndrome after Implantation of Implantable Collamer Lens

An uncommon post-operative complication where there is acute post- operative glaucoma leading to pupillary sphincter ischemia and a fixed dilated pupil It can occur secondary to retained viscoelastics or pupillary block with recurrent post-operative uveitis. This is probably the first report following ICL though it has been reported following anterior chamber phakic intraocular lens implantation Urrets-Zavalia A. Fixed dilated pupil, iris atrophy and secondary glaucoma: a distinct clinical entity following penetrating keratoplasty for keratoconus. Am J Ophthalmol.1963; 56: Tuft SJ, Buckley RJ. Iris ischemia following penetrating keratoplasty for keratoconus (Urrets-Zavalia syndrome). Cornea. 1995; 14: Maurino V., Allan BDS, Stevens JD, et al. Fixed dilated pupil (Urrets Zavalia syndrome) after air/gas injection after deep lamellar keratoplasty for keratoconus. Am J Ophthalmol. 2002; 133: Yuzbasioglu E, Helvacioglu F, Sencan S. Fixed, dilated pupil after phakic intraocular lens implantation. J Cataract Refract Surg Jan;32(1): Clinical Features & Pathophysiology of Urrets-Zavalia Syndrome REFERENCES:

Typically, 3 types of pupil dilatations can be seen: Grade I: – At least 1.5mm larger than the fellow un-operated eye, but responds to miotic agents (90%) Grade II: – Unreactive and paretic, but slowly returns to normal after time (some times up to 1 yr) Grade III: – Irreversible dilatation with iris atrophy Grading

23y old female patient Underwent bilateral Implantable Collamer Lens surgery for high myopia after necessary pre-op evaluation Post-operative course in the right eye following ICL was uneventful. The left eye ICL was performed 4 weeks after right ICL and had a protracted course with recurrent symptoms of pain, redness, photophobia and blurring of vision Case History

Day 1 post-operative visit: UCDV: 6/12; UCNV: N8 Acute rise in IOP (48mmHg), despite patent surgical peripheral iridectomy. Treated with AC wash for removal of any residual viscoelastics, systemic and topical antiglaucoma medications started. Patient also had severe anterior uveitis and was treated with topical prednisolone acetate hourly, nepafenac twice daily and moxifloxacin qid. Over the next 10days, IOP came back to normal levels but the pupil remained noticeably dilated during this period Summary of events in the left eye

UCDV: 6/9; UCNV: N6; IOP:11mmHg Oval dilated pupil with ICL in place with good vault Gonioscopy showed open angles except the nasal quadrant, which opened upto trabecular meshwork, increased pigmentation covering inferior angle structures. An unsuccessful attempt was made to surgically miose the pupil, followed postoperatively with hourly steroids and pilocarpine eye drops 1 month post-operative onwards…...

Conservative Other options: – Laqoutte (1983) proposed a regimen of sympatholytic drop (guanethidine) q4h for 1 day, followed by pilocarpine 2% for several days. – Soft coloured contact lenses – Phakic IOL explantation with clear lens extraction and IOL implantation with large, rigid iris diaphragms, overlapping interdigitating iris rings CTR with opaque iris segments intracapsular Hermeking iris prosthetic implants Current Treatment