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Femtosecond-Assisted Keratopigmentation Double Tunnel Technique in the Management of a Case of Urrets-Zavalia Syndrome

Alio, Jorge L. MD, PhD; Rodriguez, Alejandra E. MSc; Toffaha, Bader T. MD; El Aswad, A. MD, MSc

doi: 10.1097/ICO.0b013e318243f6b1
Case Report

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.

*Cornea and Refractive Surgery Department, VISSUM Corporation, Alicante, Spain

Division of Ophthalmology, Universidad Miguel Hernandez, Alicante, Spain

Research & Development Department, VISSUM Corporation, Alicante, Spain.

Reprints: Jorge L. Alio, VISSUM Corporacion Oftalmologica, Avenida de Denia s/n, 03016 Alicante, Spain (e-mail:

Supported by a grant from the Spanish Ministry of Science and Innovation, Centro para el Desarrollo Tecnológico Industrial (CDTI), CENIT: “Customized Eye Care,” CeyeC (CEN-20091021).

The authors state that they have no conflicts of interests to disclose.

The authors state that they have no proprietary interest in the products named in this article.

Received May 30, 2011

Accepted November 21, 2011

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.