Urrets-Zavalia Syndrome After Descemet Membrane Endothelial Keratoplasty (DMEK): Case Report and Review of the Literature

Purpose: The aim of this report was to describe a case of Urrets-Zavalia syndrome (UZS) after Descemet membrane endothelial keratoplasty (DMEK) and review its clinical features, incidence, pathogenesis, risk factors, and management strategies. Methods: We present the case of a 53-year-old woman with corneal decompensation secondary to a phakic intraocular lens complication, who developed UZS after DMEK. In addition to describing the intraoperative and postoperative courses, we also conducted a literature review. An analysis of the published cases summarized in “Table 1” was performed and integrated into the discussion. Results: After an uneventful DMEK procedure, the patient experienced an early postoperative intraocular pressure (IOP) elevation of up to 37 mm Hg. A reduction in the sulfur hexafluoride (SF 6 ) 20% gas bubble from 80% to 50% via paracentesis was required. On postoperative day 7, a fixed, dilated pupil (initially 7 mm, later reduced to 5 mm) with posterior synechiae was observed. Six months after DMEK, the patient underwent cataract extraction with intraocular lens implantation and achieved a best corrected visual acuity of 20/30 despite persistent medium mydriasis (5 mm). Conclusions: The use of anterior chamber gas (air or SF 6 20%) to secure the DMEK graft may lead to early postoperative ocular hypertension and subsequent UZS, especially in cases without an adequately placed inferior peripheral iridectomy (PI). Although a superior iridectomy performed during a previous phakic intraocular lens implantation may be insufficient to prevent pupillary block, an inferior PI seems crucial for preventing UZS. Analysis of the literature reveals no clear association between the type of tamponade agent used and the development of UZS, as similar complications occur with both air and SF 6 20%. Nonetheless, early IOP control and prophylactic inferior PI are strongly recommended.