2025 Clinician Corner - Urrets-Zavalia syndrome and secondary acute angle-closure glaucoma induced by implantable collamer lens

Abstract 

Implantable collamer lenses (ICL) have revolutionized the management of high refractive errors, yet they present unique challenges. We present a case of a fixed and dilated atonic pupil following acute-angle closure glaucoma from pupillary block after ICL implantation, known as Urrets-Zavalia syndrome. A 39-year-old woman developed acute ocular pain and headaches after surgery, leading to elevated intraocular pressure and subsequent complications necessitating ICL removal. This case highlights the need for prompt identification and management of elevated intraocular pressure to prevent irreversible complications such as Urrets-Zavalia syndrome following ICL implantation. 

Keywords: Implantable collamer lens; pupillary block; secondary glaucoma 

 

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Faculty credentials/disclosure 

The planners and faculty for this activity have no relevant financial relationships to disclose. The patient consented to the publication of this report.

Process

Click the "add to cart/begin" button, pay any relevant fee, take the quiz, complete the evaluation, and claim your CME credit.  You must achieve 100% on the quiz with unlimited attempts available.

  • By completing this process, you are attesting that you have read the journal article.

Expiration date:

Credit eligibility for this article is set to expire on January 1, 2026.

Learning Objectives

After completing the article, the learner should be able to:

  • Describe a common mechanism for acute glaucoma due to pupil block after implantable collamer lens placement. 

  • Apply prompt management to prevent complications such as Urrets-Zavalia syndrome. 

Key points 

  • Implantable collamer lenses (ICLs) are used to treat high refractive errors. 

  • Elevated intraocular pressure and secondary glaucoma are known complications after ICL implantation, with acute glaucoma often caused by pupillary block. 

  • Design modifications, such as adding a central hole to ICLs, or prophylactic measures such as laser peripheral iridotomy, aim to reduce the risk of angle closure, though some cases still occur. 

  • This unique case highlights the need for prompt management of elevated postoperative intraocular pressure to prevent Urrets-Zavalia syndrome and associated complications

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Course summary
Available credit: 
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance
Course opens: 
03/01/2025
Course expires: 
03/01/2026
Cost:
$25.00
Rating: 
0

  • Sruti S. Rachapudi, MD, MBAa, Michael Herron, BSb, Noor A. Laylani, MDc, Pamela A. Davila-Siliezar, MDc, and Andrew G. Lee, MDc,d,e,f,g,h 

      

    a University of Illinois Chicago, Illinois Eye and Ear Infirmary, Chicago, Illinois, USA 

    bUniversity of Nevada, Reno School of Medicine, Reno, Nevada, USA 

    c Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA 

    d Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, New York, USA 

    e Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas, USA 

    f University of Texas MD Anderson Cancer Center, Houston, Texas, USA 

    g Texas A&M College of Medicine, Bryan, Texas, USA 

    h Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA 

     

    Corresponding author: Andrew G. Lee, MD, Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, 6560 Fannin St., Ste 450, Houston, TX 77030 (e-mail: [email protected]) 

Accreditation

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation

AMA PRA Category 1 Credit™

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABS CC

Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

ABIM MOC

 Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

 

Available Credit

  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance

Price

Cost:
$25.00
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