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Journals / Journal of Experimental and Clinical Medicine / 2026 / Volume: 43 Issue: 3

Ischemic pupillary dysfunction following toric phakic intraocular lens implantation: A rare presentation of Urrets–Zavalia Syndrome

Torik Fakik Göz İçi Lens İmplantasyonu Sonrası İskemik Pupiller Disfonksiyon: Urrets-Zavalia Sendromunun Nadir Bir Sunumu

Esen Cakmak-Cengiz(Ondokuz Mayıs)0000-0003-2798-1163
Fadime Karaman Atasever(ONDOKUZ MAYIS UNIVERSITY)0000-0003-1974-9348
Ertuğrul Can(ONDOKUZ MAYIS UNIVERSITY)0000-0002-2185-6073
Pages
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Publication Date
2026-09-30
DOI
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Vigilant postoperative monitoring and meticulous surgical technique are essential to reduce the risk of this rare but significant complication.

📌 3 Key Takeaways

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Objective & Hypothesis:We aimed to report a rare case of Urrets–Zavalia syndrome (UZS) following posterior chamber toric phakic intraocular lens (pIOL) implantation and to discuss potential pathogenic mechanisms.
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Key Findings & Data:A 21-year-old woman with high myopia underwent sequential bilateral pIOL implantation.
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Conclusion & Impact:Vigilant postoperative monitoring and meticulous surgical technique are essential to reduce the risk of this rare but significant complication.
🔬Design:Case Report
📍Scope:Comprehensive Sample
⚙️Variables:Urrets-Zavalia Syndrome · Phakic Intraocular Lenses · Mydriasis

Abstract

We aimed to report a rare case of Urrets–Zavalia syndrome (UZS) following posterior chamber toric phakic intraocular lens (pIOL) implantation and to discuss potential pathogenic mechanisms. A 21-year-old woman with high myopia underwent sequential bilateral pIOL implantation. The left eye surgery was uneventful. One week later, a toric posterior chamber pIOL was implanted in the right eye. On postoperative day 1, the right pupil was fixed and dilated (8 mm) and unresponsive to light, with an intraocular pressure (IOP) of 28 mmHg. Despite prompt antiglaucomatous therapy and normalization of IOP, persistent mydriasis remained unresponsive to miotic treatment. UZS was suspected based on clinical findings. At postoperative month 3, iris cerclage was performed. At 6 months, a significant reduction in pupillary diameter and improvement in photic symptoms were observed. Early postoperative IOP elevation and intraoperative iris manipulation may contribute to ischemic sphincter damage leading to UZS after posterior chamber pIOL implantation. Vigilant postoperative monitoring and meticulous surgical technique are essential to reduce the risk of this rare but significant complication.

Özet

Amaç: Arka kamara torik fakik göz içi lens (PIOL) implantasyonu sonrası nadir görülen bir Urrets-Zavalia sendromu (UZS) vakasını bildirmek ve potansiyel patojenik mekanizmaları tartışmak. Vaka Sunumu: Yüksek miyopisi olan 21 yaşında bir kadına ardışık bilateral PIOL implantasyonu yapıldı. Sol göz ameliyatı sorunsuz geçti. Bir hafta sonra sağ göze torik arka kamara PIOL implante edildi. Ameliyat sonrası 1. günde, sağ pupil sabit ve genişlemiş (8 mm) ve ışığa tepkisizdi, göz içi basıncı (GİB) 28 mmHg idi. Hızlı antiglaukom tedavisine ve GİB'nin normalleşmesine rağmen, kalıcı midriyazis miyotik tedaviye yanıt vermedi. Klinik bulgulara dayanarak UZS'den şüphelenildi. Ameliyat sonrası 3. ayda iris serklajı yapıldı. 6. ayda pupilla çapında önemli bir azalma ve fotik semptomlarda iyileşme gözlemlendi. Sonuç: Ameliyat sonrası erken dönemde göz içi basıncının yükselmesi ve ameliyat içi iris manipülasyonu, arka kamara PIOL implantasyonundan sonra iskemik sfinkter hasarına ve UZS'ye yol açabilir. Bu nadir ancak önemli komplikasyonu azaltmak için dikkatli ameliyat sonrası izleme ve titiz cerrahi teknik şarttır.

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Cite This Article

Cakmak-Cengiz, E., Atasever, F. K., Can, E. (2026). Ischemic pupillary dysfunction following toric phakic intraocular lens implantation: A rare presentation of Urrets–Zavalia Syndrome. Journal of Experimental and Clinical Medicine, Volume: 43 Issue: 3. https://ajindex.com/articles/1422500

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