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We describe a case of Urrets-Zavalia syndrome (UZS) in a healthy 56-year-old woman who underwent femtosecond-assisted phacoemulsification with intraocular lens implantation in both eyes. One month after an uneventful postoperative course in the left eye, the right eye was operated. Dilated pupil which was nonreactive to light appeared on day 21 postoperatively. This was discovered upon examination following anterior chamber inflammatory reaction which occurred 2 weeks following her surgery. Our case report emphasizes the importance and danger in developing UZS even if the reaction in the anterior chamber does not occur immediately after surgery. In addition, the importance of intraocular pressure follow-up in the period after UZS is acknowledged.

Background. Phakic Intraocular Lens (P-IOL) implantation is a safe, easy, predictable intervention designed to manage moderate to high refractive errors. Complications are relatively uncommon and include mainly cataract and intraocular pressure spikes. Toxic Anterior Segment Syndrome (TASS) is a rather unusual sterile anterior segment inflammation after uneventful intraocular surgery, extremely rarely reported after P-IOL implantation. Urrets-Zavalia Syndrome (UZS) is also very rarely described after P-IOL. To date, to the best of the authors’ knowledge, no article has ever described the simultaneous occurrence of TASS and UZS in a patient after P-IOL implantation. Objective. In this article, the authors present the case of a female patient with moderate myopic astigmatism, who underwent sequential P-IOL implantation at two different facilities. The postoperative course of the first eye was uneventful, but she developed complications associated to the intervention in the second eye. Materials. The article describes the case of a young patient who underwent a sequential Phakic Intraocular Lens (P-IOL) implantation at two different institutions. The postoperative course of the first eye (left eye) was uneventful; however, the second eye (right eye) initially developed Toxic Anterior Segment Syndrome (TASS). Although timely and correct management was instituted, upon resolution of TASS, the patient developed Urrets-Zavalia Syndrome, anterior subcapsular cataract, and significant endothelial damage in the same eye. Results. The patient was followed closely and managed accordingly; corneal edema and anterior segment inflammation of the right eye eventually resolved. Nevertheless, an anterior subcapsular cataract and a fixed dilated pupil remained; with normal intraocular pressure (IOP). Specular microscopy confirmed an endothelial cell loss in the TASS eye (right eye). Pupil size showed no reaction to repeated doses of Pilocarpine 2%. A month after surgery, refraction on her right eye was + 0.25 + 0.75 × 93 , which resulted in a 20/50 vision. Conclusions. TASS and UZS are both extremely rare complications after uneventful P-IOL implantation, with only a handful of cases having been reported of each of them. To date, this is the very first case where UZS ensued after and potentially as a consequence of TASS in a patient who had undergone P-IOL implantation. Although a direct causative element could not be pinpointed, the fact that the complication ensued after being operated in one surgical institution and not the other, could suggest some role of different sterilization and handling procedures, but no direct conclusion can be made on this case.

BackgroundFixed dilated pupil after ophthalmic surgery or Urrets-Zavalia syndrome occurs after anterior segment surgery and usually relates to postoperative elevation of intraocular pressure. Urrets-Zavalia syndrome results in complaints of glare, halo, and photophobia. Retention of the viscoelastic agent during Implantable Collamer Lens implantation can result in postoperative elevation of intraocular pressure and Urrets-Zavalia syndrome. However, reversibility of pupillary dilatation is possible in some cases.Case presentationA 20-year-old Thai man with myopic astigmatism in both eyes underwent Implantable Collamer Lens implantation in the right eye. The preoperative slit-lamp examination of both eyes was normal, and no ectatic changes were detected from corneal tomography. One hour after the uncomplicated surgery of the right eye, intraocular pressure increased to 48 mmHg and was immediately controlled with antiglaucoma medications. Postoperative pupillary dilatation was detected, presumably due to effect of preoperative application of mydriatic drops. At postoperative day 1, the right pupil remained dilated but still reactive to light and pilocarpine 2% eye drops. Two weeks later, the left eye underwent the Implantable Collamer Lens implantation and showed neither postoperative increase in intraocular pressure nor postoperative pupillary dilatation. Two months after surgery, the dilatation of the right pupil partially reversed.ConclusionsThe findings of the right eye suggested diagnosis of Urrets-Zavalia syndrome. Compared with former reports, we noted an association between immediate control of elevation of postoperative intraocular pressure, light reactivity of the dilated pupil, and reactivity to pilocarpine 2% eye drops as potential predictors for reversibility of Urrets-Zavalia syndrome.

The article presents a case of Urrets-Zavalia syndrome development in a patient after a subtotal penetra ting keratoplasty, carried out for corneal opacity. Since this syndrome was diagnosed in time, it was possible to avoid further complications and worsening of visual functions in 25-year-old patient.

We report a case of a rare complication after trabeculotomy combined with a small trabeculectomy with mitomycin C in a young patient with juvenile glaucoma. The patient underwent uneventful surgery. However, postoperatively, he experienced a long-lasting hypotony with the need of 2 revision surgeries and 2 short episodes of high-intraocular pressure. He developed a fixed dilated pupil over time.

Purpose: To demonstrate the efficacy and initial results of single-pass four-throw pupilloplasty in cases of Urrets-Zavalia syndrome. Methods: In this prospective interventional study, single-pass four-throw was performed to reconstruct the pupil in all symptomatic cases with Urrets-Zavalia syndrome. Applanation tonometry, indentation gonioscopy, and anterior segment optical coherence tomography for anterior chamber angle assessment were performed in all the cases. Results: Out of 10 cases that were identified with Urrets-Zavalia syndrome, the procedure was performed in 7 cases, whereas 3 cases were left untreated, as they did not have any visual complaints. Five out of seven eyes had preoperative raised intraocular pressure with appositional closure of the angle. Postoperatively, intraocular pressure was controlled in all the eyes, whereas one eye required antiglaucoma medications to control the intraocular pressure. The mean preoperative and postoperative best-corrected visual acuity was 1.1 ± 1.2 and 0.4 ± 0.4 LogMar, respectively. There was a significant improvement in the best-corrected visual acuity (p = 0.0169) in the postoperative period. The mean preoperative and postoperative intraocular pressure was 26.6 ± 11.23 and 16.3 ± 2.98 mm Hg, respectively (p = 0.0168). All the patients had a minimum of 6-month follow-up period (range = 6–8 months). Conclusion: Single-pass four-throw can be employed for cases with Urrets-Zavalia syndrome, and single-pass four-throw helps to prevent the postoperative glare and narrows down the pupil size effectively. Single-pass four-throw helps to alleviate the anterior chamber angle apposition in patients with Urrets-Zavalia syndrome by mechanically pulling the peripheral iris centrally as demonstrated on anterior segment optical coherence tomography. The study also reports the occurrence of Urrets-Zavalia syndrome after glued intraocular lens surgery.

Introduction. Urrets-Zavalia syndrome (UZS) has been defined as a fixed and dilated pupil accompanied by iris atrophy and occasionally secondary glaucoma. The precise cause of the syndrome is uncertain. Most often it has been described following anterior segment surgery. The objective of this article is to present how to successfully handle patients with UZS after posterior segment surgery. We present all the dilemmas and difficulties we encountered during the diagnostic process. Case outline. This is a case presentation of a patient with UZS following scleral buckle procedure. To our knowledge, this is the first case of UZS following this type of posterior segment surgery. The delay in treatment was mostly due to the lack of knowledge about the linkage of this syndrome with posterior segment surgery. Once the diagnosis was confirmed, parasympathomimetic drops were administered. The patient responded well to the therapy and partial reduction of mydriasis and restoration of pupillary kinetics was observed. Conclusion. Two months after surgery, the treatment of UZS resulted in slight residual anisocoria with signs of iris atrophy. This could indicate reversible mechanism of UZS after posterior segment surgery with iris atrophy as the only permanent consequence.

Postoperative maximum dilated fixed pupil after penetrating keratoplasty, so-called Urrets-Zavalia syndrome, is rare. Primary insufficiency of the graft can necessitate a repeat keratoplasty. Subsequently, a segmental artificial iris reconstruction might be beneficial.

To evaluate the outcomes and complications of deep anterior lamellar keratoplasty (DALK) performed for pediatric keratoconus. This retrospective study enrolled 44 consecutive eyes of 39 keratoconus-affected children (≤ 18 years of age). All patients underwent big-bubble DALK from March 2004 to June 2016. The outcome measures included postoperative best spectacle-corrected visual acuity (BSCVA), manifest refraction, keratometry readings, and complications. The mean participant age was 16.8 ± 1.4 years, and the mean follow-up period was 68.5 ± 39.9 months. Successful big bubble was achieved in 33 eyes (75.0%), while the surgical technique was predescemetic DALK in 11 (25.0%). The mean BSCVA changed from 1.34 ± 0.49 LogMAR preoperatively to 0.24 ± 0.10 LogMAR postoperatively (P

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.

A young lady presented with very high vault and fixed dilated pupil along with optic capture of the implantable collamer lens (ICL). After thorough evaluation and ruling out the ICL sizing error, the optic capture was relieved and the ICL was rotated into vertical position. Single-pass four throw pupilloplasty was performed for the fixed dilated pupil. Postoperatively the ICL vault and the pupil size decreased and patient was asymptomatic. This case highlights a successful outcome of rotation of a nontoric ICL to reduce the high vaulting and optic capture along with single-pass four throw pupilloplasty.

We describe the case of a healthy 28-year-old woman who underwent implantation of a posterior chamber, phakic, toric, implantable Collamer lens (ICL) in both eyes for correction of bilateral high myopia with astigmatism. On the first postoperative day the patient developed increased intraocular pressure (IOP) and a fixed, mid-dilated pupil in her left eye. The elevated IOP was corrected within 3 days by medical treatment. However, the pupil remained mid-dilated and nonreactive to both light and accommodative effort during 2 months of follow-up; there was no reaction to pilocarpine (0.125% or 4%) eyedrops. The patient was diagnosed with Urrets-Zavalia syndrome (UZS), which has been reported in association with ICL implantation only once previously.

Purpose To present a case series of patients that developed Urrets-Zavalia syndrome (UZS) after deep anterior lamellar keratoplasty (DALK) for treating keratoconus and discuss the mechanisms for the syndrome. Materials and methods Retrospective chart analysis of patients who developed UZS after DALK at the Cornea Unit, Hospital São Geraldo, Federal University of Minas Gerais. Results We present a series of 3 patients with features consistent with UZS, after undergoing DALK. Elevated intraocular pressure (IOP) was noted in the early postoperative period in 2 cases, despite the fact that the other case reported eye pain, headache, and nausea at the night after the surgery with undocumented IOP. Although at different extents, the pupil remained atrophic and dilated in all 3 eyes, and 2 of them developed anterior subcapsular cataract. Conclusion Iris ischemia resulting from occlusion of iris root vessels due to elevated IOP higher than diastolic blood pressure causes UZS. Elevated IOP should be monitored, especially in young patients with low diastolic blood pressure, in order to avoid the occurrence of the syndrome. How to cite this article Reis JRC, Diniz-Filho A, Rocha FM, Torquetti L. Pathogenesis of Fixed Dilated Pupil (Urrets-Zavalía Syndrome) after Deep Lamellar Keratoplasty in Keratoconus. Int J Kerat Ect Cor Dis 2016;5(1):32-34.

Objective To report the occurrence of 5 cases of Urrets-Zavalia syndrome after transscleral diode laser cyclophotocoagulation (TSCPC). Design Retrospective cases series. Methods A review of the charts of 5 patients treated with TSCPC as primary glaucoma surgery who developed Urrets-Zavalia syndrome. Results A total of 8 eyes of 5 patients developed a fixed and dilated pupil after TSCPC, unresponsive to light. A mydriatic pupil could still be observed at least 6 months after treatment in 7 of 8 eyes; however, it was asymptomatic. Conclusions Urrets-Zavalia syndrome is a possible complication of TSCPC, as well as of other 360-degree thermal laser procedures.

Case report The first case is described on a patient with Urrets-Zavalia syndrome after Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) in whom an ExPRESS implant was used. Discussion The ExPRESS implant is a useful tool for complex cases of post-surgical glaucoma where patients need to avoid post-operative inflammation and risks (corneal transplant patients). It is also very useful in cases with a high risk of fibrosis due to previous interventions.

PURPOSE To describe the successful use of a double intrastromal tunnel femtosecond-assisted keratopigmentation technique to manage a case of unilateral Urrets-Zavalia syndrome. METHODS A 33-year-old man was referred with a history of trauma in his right eye due to a labor-related accident. Because of myopic anisometropia, he had been previously implanted with an angle-supported phakic intraocular lens. The patient presented iris atrophy and a fixed dilated pupil. He complained of severe and incapacitating photophobia, glare, and decreased vision. To obtain a complete iris replica, the surgery involved creation of double keratopigmented intrastromal tunnels using femtosecond laser and micronized mineral pigments. The deepest layer was stained black first and then the superficial layer was stained with a contoured greenish blue-gray color, which matched the contralateral eye. RESULTS In the immediate postoperative period, the patient reported a complete elimination of photophobia associated with the corrected distance visual acuity improvement. A very adequate cosmetic outcome was also achieved. Stability was observed during the 12-month follow-up. CONCLUSION A femtosecond-assisted keratopigmentation technique using 2 pigmented intrastromal tunnels to achieve an intracorneal pigmented replica of the iris was effective in improving the patient's severe visual function disability and cosmetic appearance. To the best of our knowledge, this is the first report of severe visual function disability caused by atrophic iris and a fixed dilated pupil treated with double intrastromal layers of keratopigmentation by means of femtosecond-created tunnels.

Urrets-Zavalia Syndrome (UZS) was described 50 years ago as the appearance of a fixed and dilated pupil following penetrating keratoplasty for keratoconus in patients receiving atropine. The mechanism of UZS has still not been fully determined, but an acute increase in intraocular pressure and ischemia of the iris most probably play a major role. Fixed and dilated pupils also occur in association with other ophthalmic surgeries, such as lamellar keratoplasties, cataract surgery, and glaucoma procedures. Some have questioned the existence of this syndrome, as well as the linkage to keratoconus and use of mydriatics. We review the pathophysiology, etiology, and clinical presentation of fixed and dilated pupils following ophthalmic procedures.

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.

Urrets-Zavalia syndrome is a surgical complication in which the pupil remains fixed and dilated after a procedure. It is believed to be caused by brief periods of high intraocular pressure. Although the syndrome was originally associated with penetrating keratoplasty, it has subsequently been associated with other procedures. We report the case of a 13-year-old boy with congenital glaucoma who developed Urrets-Zavalia syndrome after goniotomy. After 2 years of follow-up, the pupil remained fixed and dilated in that eye. To our knowledge this is the first case of Urrets-Zavalia syndrome to be reported following goniotomy and the first to occur in a child.

Sir, Cidofovir (HPMPC) is widely used for the treatment of CMV retinitis and is also effective against VZV and HSV.1 This treatment can be responsible for two ocular side effects: anterior uveitis and severe and prolonged ocular hypotony.1, 2 Ocular hypotony can be irreversible despite specific treatment with poor visual prognosis.1, 2 The suspected physio-pathogenic mechanism of this complication is a direct toxicity of cidofovir on the ciliary body.2, 3

PURPOSE To report a fixed dilated pupil and anterior subcapsular cataract formation following Descemet stripping endothelial keratoplasty (DSAEK). METHODS A 47-year-old man with Fuchs endothelial dystrophy underwent DSAEK of the right eye. The preoperative slit lamp examination was normal. Mydriatic drops were used at the end of procedure. RESULTS Postoperatively, the pupil remained fixed and dilated with no right direct or consensual response to light, or constriction during accommodation throughout a 1-year follow-up period. Slit lamp examination after air resorption revealed a transient anterior subcapsular cataract and posterior synechiae. Based on these findings, a diagnosis of Urrets-Zavalia syndrome was made. CONCLUSION To our knowledge, this is the first report of Urrets-Zavalia syndrome after DSAEK.

PURPOSETo report a patient who had a fixed and dilated pupil after uneventful iris-claw phakic intraocular lens (IOL) implantation. METHODSA 27-year-old woman with bilateral high myopia underwent bilateral implantation of iris-claw phakic IOLs. RESULTSNo specific ocular findings were noted until postoperative week 1. Intraocular pressure (IOP) was within normal range in both eyes after surgery. At postoperative week 2, the right pupil was normal, but the left pupil was fully dilated and non-reactive to light, accommodative effort, and 0.125% and 2% pilocarpine. Best spectacle-corrected visual acuity was 1.0, and IOP was 13 mmHg in the left eye. There was no history of perioperative mydriatic use. CONCLUSIONSUrrets-Zavalia syndrome, unrelated to IOP elevation, occurred after uneventful phakic IOL implantation. Clinicians performing phakic IOL implantation should be aware of this complication. [J Refract Surg. 2008;24:959-961.] AUTHORS From the Department of Ophthalmology and Visual Science, Kangnam St Mary’s Hospital, The Catholic University of Korea, College of Medicine (Park, Yang); and Glory St Mary’s Eye Center (S.Y. Kim, H.I. Kim), Seoul, Korea. The authors have no proprietary interest in the materials presented herein. Correspondence: Suk Woo Yang, MD, PhD, Dept of Ophthalmology and Visual Science, College of Medicine, Catholic University of Korea, 505 Banpo-dong, Socho-gu, Seoul 137-701, Korea. Tel: 82 2 590 2761; Fax: 82 2 599 7405; E-mail: yswoph@hanmail.net Received: June 19, 2008 Accepted: June 26, 2008 Posted online: July 31, 2008

We report a case of pharmacologic regression of Urrets-Zavalia syndrome, following deep lamellar keratoplasty for severe keratoconus. Sympatholytic and parasympathomimetic drops were administered and a progressive reduction of mydriasis and restoring of pupillary kinetics were observed. Four years after surgery, it was resulting in only slight residual anisocoria.

We report a case of fixed, non-reactive pupil (Urrets-Zavalia syndrome) in a 34-year-old patient following laser-assisted in situ keratomileusis (LASIK) caused probably by intermittent postoperative intraocular pressure fluctuations. This case highlights the possibility of a fixed and dilated pupil even after LASIK, a technically non-intraocular surgery, which is due to a preventable cause: postoperative intraocular pressure fluctuations. To the best of our knowledge, this is the first report of Urrets-Zavalia syndrome following LASIK.

Purpose To report fixed dilated pupil following penetrating keratoplasty for corneal dystrophies. Methods Retrospective chart analysis of subjects who underwent penetrating keratoplasty for corneal dystrophies between 1998 and 2002 at our institute. Results Three of the subjects with fixed dilated pupils after penetrating keratoplasty had Macular corneal dystrophy and one subject had Fuchs Endothelial dystrophy. Fixed dilated pupils were noticed in the immediate postoperative period. None of the subjects had evidence for glaucoma either pre- or postoperatively. The follow up period ranged from 5 to 18 months. Conclusions Fixed dilated pupil (Urrets-Zavalia syndrome) can occur after penetrating keratoplasty for corneal dystrophies and may not be limited to eyes with keratoconus as previously reported.

Urrets−Zavalia syndrome as a complication of ocular hypotonia due to intravenous cidofovir treatment

This report describes the histopathological and ultrasound biomicroscopy findings of a 35-year-old woman with keratoconus who developed an irreversible mydriasis after keratoplasty.

We welcome this opportunity to respond to the letter by Huisingh and McGewin1 regarding our study entitled ‘Cluster of Urrets-Zavalia syndrome: a sequel of toxic anterior segment syndrome’.2 They suggested that we re-analyse our data of the best corrected visual acuity (BCVA) of our patients by comparing the BCVA on first postoperative day to that at first month …

In the recently published study by Nizamani et al ,1 the authors collected data on a best corrected visual acuity (BCVA) following cataract surgery among a group of patients with Urrets-Zavalia syndrome. Using a repeated-measures design, data were collected from subjects preoperatively and at first day, first week and first month postoperatively. We would like to comment on the author's methodology as well as the statistical analysis used. To assess improvement in vision, the authors compared preoperative vision and 1 month postoperative vision (see table 3 in original …

A fixed dilated pupil following penetrating keratoplasty is a well recognised if rare postoperative complication. We report a case of Urrets-Zavalia syndrome following a deep lamellar keratoplasty (DLK). To our knowledge this association has not been previously described. The mydriasis following penetrating keratoplasty was first described by Castroviejo (Castroviejo R, personal communication) but it was Urrets-Zavalia who first published his observations on a series of six cases and suggested an association of fixed dilated pupil, iris atrophy, and secondary glaucoma.1 The incidence of this syndrome is estimated at 5.8%, from pooled data on 445 eyes undergoing penetrating keratoplasty for keratoconus, of which 24 eyes developed a fixed dilated pupil.2 Davies and Ruben also found a similar incidence.3 However, other more recent studies find no cases,4–6 and some even question its continued existence. This may in part reflect improved surgical technique and differing diagnostic criteria. The pupil can become abnormally dilated following penetrating keratoplasty for keratoconus, particularly if dilating drops are used. There are three main groups of pupillary dilatation.2 (1) A pupil with normal light and near reaction which is at least 1.5 mm larger than its fellow unoperated eye. It fully constricts with topical miotics. An …

Purpose: To report three cases of Urrets-Zavalia syndrome after deep lamellar keratoplasty. Case summary: A retrospective chart analysis of two men who underwent deep lamellar keraplasty after corneal chemical burns and one woman who was treated with deep lamellar keratoplasty due to lattice dystrophy was performed. To maintain the anterior chamber depth and prevent formation of a double anterior chamber after deep lamellar keratoplasty, air or gas (C3F8) was injected into the anterior chamber for all three cases. After injections of air or gas (C3F8) into the anterior chamber, pupillary blocks occurred and intraocular pressures increased. Afterwards, intraocular pressures were well-controlled, but the pupil remained irreversibly fixed and dilated despite the use of miotics. Conclusions: Urrets-Zavalia syndrome, a postoperative complication, was first reported in a patient who underwent penetrating keratoplasty for keratoconus. This syndrome can also occur after deep lamellar keratoplasty on rare occasions.

A 19-month-old boy attended the paediatric assessment unit with asymmetrical pupils. This had first been noticed 8 h previously. The boy had asthma for which he was prescribed both salbutamol and ipratropium bromide inhalers, which were given via a spacer and facemask. That morning, inhaler administration had been difficult, as his mother’s attempts to deliver …

Editor,—A fixed and dilated pupil is an uncommon postoperative complication first described by Urrets-Zavalia following penetrating keratoplasty for keratoconus.1 We report the same problem occurring in two patients after uncomplicated trabeculectomy. To the best of our knowledge, such cases have not been previously described in the literature. ### CASE 1 A 38 year old woman with bilateral advanced glaucoma was referred for further management of her condition. Her ophthalmic history included surgery to her left squint as a child and left amblyopia. She was otherwise fit and well and took no systemic medication. On examination her best corrected visual acuities were 6/6 in the right eye and 6/36 in the left with a left relative afferent pupillary defect. Her anterior segments were normal and her intraocular pressure (IOP) was 19 mm Hg bilaterally on timoptol twice daily. Gonioscopy revealed open angles and funduscopy showed …

A fixed and dilated pupil is an uncommon postoperative complication after penetrating keratoplasty (PK) for keratoconus. Although the clinical features have been well described, the precise aetiology is uncertain. We performed anterior segment fluorescein angiography in the early postoperative period on three patients who developed fixed, dilated pupils after apparently uncomplicated surgery. All of the eyes had severe iris ischaemia. A possible role for a postoperative rise in intraocular pressure in the aetiology of this syndrome is discussed.

After penetrating keratoplasties for different congenital or acquired corneal diseases, the presence of characteristic cataracta glaucomatosa lens opacities was noted in 9 cases of fixed, dilated pupi