Urrets-Zavalia syndrome following iris-claw phakic intraocular lens implantation

To report a patient who had a fixed and dilated pupil after uneventful iris-claw phakic intraocular lens (IOL) implantation.

A 27-year-old woman with bilateral high myopia underwent bilateral implantation of iris-claw phakic IOLs.

No 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.

Urrets-Zavalia syndrome, unrelated to IOP elevation, occurred after uneventful phakic IOL implantation. Clinicians performing phakic IOL implantation should be aware of this complication.