Urrets-Zavalia Syndrome following cataract surgery in a case of anterior megalophthalmos / Síndrome de Urrets-Zavalia após cirurgia de catarata em um caso de megaloftalmo anterior

ABSTRACT Intraoperative and postoperative cataract surgery in eyes with anterior megalophthalmos are challenging procedures. Herein we describe the case of a 53-year-old male with anterior megalophthalmos who developed unilateral Urrets-Zavalia Syndrome following cataract surgery.

RESUMO O intraoperatório e o pós-operatório de cirurgia de catarata em olhos com megaloftalmo anterior é desafiador. Descrevemos o caso de um homem de 53 anos com megaloftalmo anterior que desenvolveu a Síndrome de Urrets-Zavalia unilateral após cirurgia de catarata.

Update and review of Urrets-Zavalia syndrome / Atualizando e revisando a síndrome de Urrets-Zavalia

ABSTRACT For more than half a century, Urrets-Zavalia syndrome (fixed dilated pupil) has been described as a postoperative complication of ophthalmic surgery. Since first reported as a complication of penetrating keratoplasty for keratoconus in patients receiving atropine, the characteristic features of Urrets-Zavalia syndrome have been expanded. In previous literature, a total of 110 cases resulted in a fixed and dilated pupil. Increased intraocular pressure (IOP) in the immediate postoperative period, phakia, and air or gas in the anterior chamber appear to be the most important risk factors for Urrets-Zavalia syndrome following ophthalmic procedures. Mannitol, IOP control, the removal of air or gas in the anterior chamber, and iridectomy have all demonstrated utility in managing Urrets-Zavalia syndrome.

RESUMO Por mais de meio século, a síndrome de Urrets-Zavalia (pupila fixa e dilatada) foi descrita como uma complicação pós-operatória em oftalmologia. Desde o primeiro relato após ceratoplastia penetrante em pacientes portadores de ceratocone em uso de atropina, seu conceito foi ampliado. Na literatura, um total de 110 casos resultaram em pupila fixa e dilatada. Aumento da pressão intraocular (PIO) no pós-operatório imediato, facia, ar ou gás na câmara anterior parecem ser fatores de risco importantes para o aparecimento da síndrome. Sua prevenção pode ser alcançada com o uso de manitol, controle adequado da PIO e quantidade de ar ou gás na camâra anterior e iridectomia.

Comparison of head and shoulder posture in blind, deaf and ordinary pupils

Proprioceptive, vestibular and visual senses control human movements. This study was carried out to compare the posture of head and shoulder in blind, deaf and ordinary pupils. This descriptive and analytic study was done on 16 blind, 30 deaf and 60 ordinary pupils in Ardabil city, Noth-west of Iran. Sagital and frontal planes Photos for each child was used for determination of head and shoulder deviation. Forward head in blind group significantly was lower than deaf and ordinary pupils [P<0.05]. Rounded shoulder in blind and deaf pupils significantly was lower than ordinary pupils [P<0.05]. Uneven shoulders in deaf pupils significantly was lower than ordinary and blind children [P<0.05]. Lateral flexion of the head in blind and deaf pupiles significantly was higher than ordinary children [P<0.05]. There is a relationship between sensory impairment and postural problems paticularly in blindness Pupils

Complicações em transplantes endoteliais realizados por estagiários de córnea / Complications in endothelial keratoplasty performed by cornea fellows

OBJETIVO: Reportar complicações precoces numa série de transplantes endoteliais realizados por estagiários de córnea. MÉTODOS: Revisão retrospectiva dos transplantes endoteliais realizados por estagiários de córnea do segundo ano. Descritas as complicações precoces e respectivo tratamento. RESULTADOS: Foram realizados 34 transplantes endoteliais pelos estagiários de córnea entre julho de 2007 e agosto de 2008. Destes, 29 foram realizados pela técnica de "Descemet stripping endothelial keratoplasty" e 5 "Descemet stripping automated endothelial keratoplasty". Foram realizadas 15 cirurgias combinadas, 14 associadas a facoemulsificação com implante de lente intraocular e 1 associada a facectomia com implante de lente intraocular. A principal indicação foi por distrofia de Fuchs com 18 casos, 11 foram indicados por ceratopatia bolhosa após cirurgia de catarata, 4 por falência primária após transplante endotelial e 1 por distrofia endotelial congênita hereditária. A complicação mais encontrada foi descolamentos do botão doado em 8 olhos (23,5%). Falência primária foi encontrado em 7 olhos (20,6%). Glaucoma agudo por bloqueio pupilar foi encontrado em 1 paciente (2,9%). CONCLUSÕES: O alto número de complicações encontradas nestas cirurgias, que foram as primeiras de um grupo de 6 estagiários de córnea, mostra a longa curva de aprendizado para este procedimento cirúrgico. A orientação das primeiras cirurgias por cirurgiões mais experientes pode diminuir a curva de aprendizado e a taxa de complicações.

PURPOSE: To report early complications in endothelial keratoplasty performed by cornea fellows. METHODS: Retrospective study of endothelial keratoplasty performed by second-year cornea fellows. Described the early complications and its treatments. RESULTS: Thirty four endothelial keratoplasty were performed by cornea fellows, from July 2007 to August 2008. From this, 29 were Descemet stripping endothelial keratoplasty and 5 Descemet stripping automated endothelial keratoplasty; 14 combined with phacoemulsification and 1 with extracapsular cataract surgery. The main indication was Fuchs' dystrophy (18 cases), followed by bullous keratopathy (11 cases), primary failure after endothelial keratoplasty (4 cases) and congenital hereditary endothelial dystrophy (1 case). Main surgery complication was donor button detachment in 8 eyes (23.5%), followed by primary graft failure in 7 eyes (20.6%) and acute glaucoma after pupillary block in 1 eye (2.9%). CONCLUSIONS: The complication rate in this series, which were the first ever in a group of six cornea fellows, was high. This shows the steep learning curve for this surgical procedure. The assistance of an experienced surgeon could help to achieve a less steep learning curve with a lower complication rate.

Paradoxical reaction in tubercular meningitis resulting in involvement of optic radiation.

A 25-year-old woman was diagnosed to have tubercular meningitis (TBM) with a right parietal infarct. She responded well to four-drug anti-tubercular treatment (ATT), systemic steroids and pyridoxine. Steroids were tapered off in one and a half months; she was put on two-drug ATT after two months. Six months after initial diagnosis she presented with sudden, bilateral visual loss. Vision was 3/200 with afferent pupillary defect and un-recordable field in the right eye; vision was 20/60 in the left eye, pupillary reaction was sluggish and the field showed a temporal hemianopia. On reintroduction of systemic corticosteroids vision improved (20/120 in right eye and 20/30 in left eye) within three days; the field defects improved sequentially to a left homonymous hemianopia, then a left homonymous inferior quadrantonopia. A diagnosis of TBM, on treatment, with bilateral optic neuritis, and right optic radiation involvement was made. Since the patient had been off ethambutol for four months, the optic neuritis and optic radiation lesion were attributed to a paradoxical reaction to tubercular allergen, corroborated by prompt recovery in response to corticosteroids. This is the first report of optic radiation involvement in a paradoxical reaction in neuro-tuberculosis in a young adult.

Long term outcome in patients with severe head injury and bilateral fixed dilated pupils.

Patients with severe head injury with bilateral dilated unreactive pupils are considered to have a grave prognosis. Hence proper planning and aggressive management becomes mandatory for achieving good results. We present the outcome of consecutive 166 patients with severe head injury, admitted between January 1996 and December 2000 and analysed retrospectively. All the patients had an initial GCS of 8 or less and post resuscitation bilateral dilated unreactive pupils. Our aim was to analyze the long term outcome in these patients and identify the other significant prognostic factors. Of the 166 patients, 42 (25.30%) had a functional outcome (good recovery in 10.24%, moderate disability in 15.06%), and 124 (74.69%) had a poor outcome (death in 58.43% and severe disability in 16.26% of cases). There were 45 patients with polytrauma and 24 of these patients (53.33%) succumbed to the injuries. Obliteration of the basal cisterns and contusion were the common CT scan findings. Factors adversely affecting the survival included age of the patient, polytrauma with shock, initial GCS of 3 or 4, and compression of the basal cisterns on the initial CT scans. At follow up, most of the patients with a functional outcome showed a significant improvement in their motor function but continued to have neuro-behavioral and cognitive deficits.

Anormalidade Pupilar rara na sinusopatia maxilar / Rare pupillary abnormality in maxilary sinusopathy

Sinusites podem acometer tecidos adjacentes, dentre eles o sistema nervoso. Neste trabalho descrevemos um caso de sinusopatia maxilar ocasionando anormlidade pupilar rara com reaçäo paradoxal à luz. Que seja de nosso conhecimento é a primeira vez que esta associaçäo é descrita

Pupila atónica y atrofia iridiana postcirugía intraocular de polo anterior: síndrome de Urrets-Zavalía / Atonic pupil and iridian atrophy due to intraocular surgery: Urrets-Zavalia's syndrome

Se describen 5 casos de pupila parética postcirugía intraocular. Dos casos se presentaron después de injertos corneales penetrantes en queratopatía herpética, un caso fue consecuencia de la aspiración de una catarata blanda sin implante intraocular y dos casos se presentaron después de operaciones de trabeculotomía en ojos con glaucoma crónico de ángulo abierto. Casi todos los casos de pupila parética publicados haste este momento se presentaron después de queratoplastías penetrantes, en general queratoplastías practicadas en ojos con queratocono. Existen muy pocos casos publicados de este síndrome postfacoéresis con implante de lente intraocular. En este trabajo describimos los dos primeros casos de síndrome de la pupila parética como consecuencia de cirugía para el glaucoma de ángulo abierto y llamamos la atención sobre el hecho de que esta rara complicación, originalmente relacionada exclusivamente con la queratoplastía penetrante, también puede observarse después de otros tipos de cirugía del segmento anterior del ojo. Se discuten las teorías etiopatogénicas más relevantes propuestas para este síndrome