To describe Urrets-Zavalia syndrome in different methods of keratoplasty.

In a retrospective study, we reviewed charts of the eyes that underwent penetrating keratoplasty (PKP), descemet stripping endothelial keratoplasty (DSEK) and deep anterior lamellar keratoplasty (DALK) since 2008 until 2012. Eyes with a documented postoperative fixed dilated pupil following surgery were included in the results as Urrets-Zavalia syndrome. Demographic data, ocular and drug history, pre and postoperative examinations were reviewed.

Eight hundred eleven eyes underwent PKP, DALK and DSEK during the time of the study. There were eight eyes (seven patients) of U-Z syndrome during the study. No eyes had a history of intraoperative mannitol injection and there was not any history of iris prolapse during the surgery. There was a history of gas injection in six of eight cases. Five of eight eyes developed U-Z syndrome after DALK procedure. All of these cases were associated with intracameral air injection.

Urrets-Zavalia syndrome could occur in each type of keratoplasty especially those associated with intracameral gas injection. Although the incidence was low in our study (1%), it necessitates pre, intra and postoperative managements in susceptible patients.