Filtering Pseudo-Bleb Secondary to Sutured Posterior Chamber Intraocular Lens with Implications for Ocular Surgery in Marfan Syndrome

Abstract

A 51-year-old female Caucasian patient with a history of Marfan syndrome and multiple previous bilateral ocular surgeries presented with increasing discomfort, epiphora, and blurred vision in her right eye for a few months. On examination, we found an overhanging cystic Seidel-positive filtering pseudo-bleb with hypotony in her right eye and a smaller Seidel-negative filtering pseudo-bleb in the left eye secondary to sutured intraocular lens (IOL) in both eyes. Intraoperatively, two full-thickness scleral defects were found close to the limbus, suggesting a melting flap in the location of the previous sutured IOL implant in the right eye. The defects were plugged with two pieces of donor sclera and covered with a larger donor scleral patch, the ischemic conjunctiva was excised, and the remaining healthy conjunctiva was advanced and sutured along the limbus. At last follow-up, intraocular pressure and vision in the right eye increased to preoperative levels, and no pseudo-bleb or leak was detected.

Keywords: Marfan syndrome; bleb leak; pseudo-bleb; sutured intraocular lens.