Clinicians describe treatment of scleral melt in patient with Marfan syndrome

Clinicians from King George’s Medical University in Lucknow, India, have described their treatment of a patient with Marfan syndrome who experienced scleral melt.

Writing in BMJ Case Reports, the authors outlined how a young man presented to the outpatient department reporting a loss of vision over the past eight years, which had become worse in the past three years.

Although he wore prescribed spectacles, he did not experience an improvement in vision.

An ocular examination revealed a superonasal lens subluxation with a myopic fundus in both eyes.

Following a pars plana lensectomy with anterior vitrectomy, the case report authors described how the patient developed low intraocular pressure in his left eye followed by spontaneous scleral melt.

The patient received emergency surgery to place an amniotic membrane graft over the area of scleral melt and was prescribed oral ciclosporin.

The authors highlighted that the patient’s globe stabilised, with his vision increasing from 1/60 the day after surgery to 6/24 a week post-surgery with normal intraocular pressure.

“Postoperatively, my condition became better and my vision improved as well,” the patient shared as part of the case report.

“Currently, my vision is stable under the effect of prescribed glasses with no fresh complaints,” he said.

Learning points discussed in the case report include the fact that a spontaneous scleral rupture is a rare complication in Marfan syndrome.

The authors shared: “Prompt surgical repair with either preserved donor scleral patch graft or amniotic membrane graft with appropriate conjunctival closure technique can preserve the vision and integrity of the globe.”