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Dislocated IOL and Spontaneous Filtering Bleb in Patient With Marfan Syndrome

Truong Andy Vu, OMS, MBS, and Sami Uwaydat, MD

Truong Andy Vu, OMS, MBS, and Sami Uwaydat, MD, describe the surgical management of a patient with Marfan syndrome who presented with a dislocated IOL and hypotony resulting from a spontaneous filtering bleb. Conjunctival peritomy revealed a 6-8 mm limbal corneoscleral perforation under the bleb. The perforation was initially closed with 10-0 nylon sutures. A scleral tunnel was fashioned in the temporal quadrant. A 25g pars plana vitrectomy was performed, and the dislocated IOL was removed through the temporal scleral tunnel using a bimanual technique. The scleral tunnel was successfully closed with interrupted 10-0 nylon sutures. Although additional 10-0 nylon sutures were used to close the initial limbal perforation, they were unable to provide a watertight closure. A scleral patch graft was sutured over the perforation using a combination of 10-nylon and 8 -0 vicryl sutures. At the 4-week postop followup, the IOP had increased to 28 mmHg, and both choroidal and corneal folds resolved. In patients with Marfan syndrome, closure of the thin sclera and cornea may be challenging. Therefore, we suggest suturing a scleral patch graft as a method to achieve anatomical closure.

Posted: 9/27/2023