Título

BILATERAL URRETZ-ZAVALIA SYNDROME AFTER PHACOEMULSIFICATION COMPLICATED WITH REFRACTORY GLAUCOMA: A CASE REPORT

Objetivo

To report a case of bilateral Urretz-Zavalia syndrome (UZS) after phacoemulsification complicating with glaucoma.

Relato do Caso

A 42-year-old Latin woman with myopia (axial length of 27.22 and 25.48 mm), presenting a cataract caused by long-term corticosteroid use due to asthma, underwent phacoemulsification in both eyes (OU). She denied any other pathological conditions. Uneventful surgery was performed in OU, with the left eye (OS) being operated 1 month after the right eye (OD). Following each surgery, she complained of blurred vision, ocular pain, and redness, with intraocular pressure (IOP) up to 54/34 mmHg. Because of refractory to hypotensive eyedrops, she underwent trabeculectomy in OS. After 10 years, she presented best-corrected visual acuity of 20/800 in OU. Biomicroscopy (Fig. 1A and B) revealed flat trabeculectomy bleb in OD; endothelial pigments, 2+ cells in the anterior chamber (AC), and multiple iris changes in OU; uveal ectropium and superior iridectomy were observed only in OD. There was no iris transillumination (Fig. 1C and D), but a single-piece intracapsular lens could be seen in OU. Fundoscopy revealed myopic changes and subtotal excavation/disc in OU, besides a pale disc in OD (Fig. 2A and B). IOP was 32/45 mmHg, and gonioscopy revealed a closed angle with goniosynechiaes in OU. Optical coherence tomography showed severe defects in the retinal nerve fiber layer in OU (Fig. 2C and D). Work-up showed positivity only for IgG antibodies against herpes virus. Oral acyclovir at 4 g/day (30 days) was prescribed, and despite optimized therapy, she persisted with inflammation and high IOP levels. Diagnosis of bilateral UZS complicated with glaucoma was hypothesized, and she was treated with micropulse transscleral diode cyclophotocoagulation (MP-TSCPC) in OU, reaching IOP reduction and stability.

Conclusão

Bilateral UZS may occur after phacoemulsification and can be complicated by ocular hypertension. In such cases,
combining MP-TSCPC may help reach adequate IOP levels