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.
Keywords: Fixed dilated pupil; Iris atrophy; Keratoplasty; Postoperative intraocular pressure decompensation; Urrets-Zavalia syndrome.