Timely intervention of spontaneous scleral melt in Marfan syndrome

A young man in his late adolescence presented with a gradually progressive diminution of vision in both eyes for 3 years. A general physical examination revealed features suggestive of Marfan syndrome, with a positive family history. Ocular examination revealed a superonasal lens subluxation with a myopic fundus in both eyes. The patient underwent pars plana lensectomy with anterior vitrectomy in the right eye followed by the left eye. The right eye surgery was uneventful, and the patient was left aphakic. On the first postoperative day, the left eye developed hypotony. By the second day, spontaneous scleral melt was noted posterior to the surgical wound with severe hypotony and loss of globe architecture. The patient was taken up for emergency surgery with an amniotic membrane graft over the area of scleral melt and was started on oral ciclosporin (100 mg). Postoperatively, the patient's globe stabilised. After 1 week, the patient's vision increased to 6/24 with normal intraocular pressure.