Fixed dilated pupil (Urrets-Zavalia syndrome) after air/gas injection after deep lamellar keratoplasty for keratoconus

Am J Ophthalmol. 2002 Feb;133(2):266-8. doi: 10.1016/s0002-9394(01)01308-3.


Purpose: To describe three cases of fixed dilated pupil and presumed iris ischemia (Urrets-Zavalia syndrome) after anterior chamber air/gas injection after deep lamellar keratoplasty for keratoconus.

Methods: Interventional case series. Three eyes of three patients with keratoconus underwent deep lamellar keratoplasty and intraoperative or postoperative injection of air/gas in the anterior chamber to appose the host-donor lamellar graft interface.

Results: Urrets-Zavalia syndrome was diagnosed on clinical grounds in three cases and was associated with the Descemet membrane microperforation intraoperatively and introduction of air/gas into the anterior chamber intraoperatively or postoperatively.

Conclusion: A fixed dilated pupil is an uncommon complication of penetrating keratoplasty for keratoconus that can also develop after deep lamellar keratoplasty. Leaving an air or gas bubble in the anterior chamber of a phakic eye after deep lamellar keratoplasty is a risk factor and should therefore be avoided.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Air*
  • Anterior Chamber
  • Atrophy
  • Corneal Transplantation / adverse effects*
  • Female
  • Humans
  • Injections
  • Iris / pathology*
  • Keratoconus / surgery*
  • Male
  • Middle Aged
  • Mydriasis / diagnosis
  • Mydriasis / etiology*
  • Sulfur Hexafluoride / adverse effects*
  • Syndrome


  • Sulfur Hexafluoride