Filtering pseudo-bleb secondary to sutured posterior chamber intraocular lens with implications for ocular surgery in Marfan syndrome

A 51-year-old female Caucasian patient with the history of Marfan syndrome and multiple previous bilateral ocular surgeries presented with increasing discomfort, epiphora and blurry 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 side secondary to sutured intraocular lens (IOL) in both eyes. Intraoperatively, 2 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 2 pieces of donor sclera, covered with a larger donor sclera patch, ischaemic conjunctiva excised and remaining healthy conjunctiva advanced and sutured along the limbus. At last follow up, the right intraocular pressure and vision increased to the preoperative levels; no pseudo-bleb or leak was detected.