Wavefront aberrations in Marfan syndrome over time after refractive surgery

AIM. To study aberrations of the optical system of the eye in patients with ectopia lentis in Marfan syndrome and their changes after surgical treatment. MATERIALS AND METHODS: The study included 20 patients (38 eyes) with Marfan syndrome with lens subluxation of varying severity, aged 5 to 36 years (23.7±5.2), and who received treatment at the Helmholtz National Medical Research Center of Eye Diseases in 2017 to 2024. Surgical treatment of ectopia lentis involved removal of the subluxated lens followed by implantation of an intraocular lens (IOL) and an intracapsular tension ring. It was performed in 9 patients (16 eyes) from the study group of patients with Marfan syndrome, namely, in 5 girls and 4 boys aged 5 to 15 years (mean: 12.1±3.2 years). The examination of children included autorefractometry, biomicroscopy, ophthalmoscopy, keratometry, tonometry, ultrasound biometry, and aberrometry. Follow-up periods ranged from 3 months to 2 years. RESULTS: The conducted examinations showed that eyes with keratoconus had a sharp increase in all common (and, above all, internal) aberrations caused by a change in the position of the lens, its tilt (which contributes to the tilt aberration), vertical and horizontal decentration (vertical and horizontal coma and trefoil), a more convex shape due to the impossibility of tensioning the ciliary zonules that flatten the lens in the healthy eye (spherical aberration), a change in the clarity and quality of the lens surface (trefoil). CONCLUSION: In Marfan syndrome, all common and internal wavefront aberrations of the eye are sharply increased. Vertical (×2,000 times) and horizontal (×1,000 times) tilt, vertical (×7,000 times) and horizontal (×130,000 times) coma, and vertical trefoil (×900 times) demonstrate extreme values. After surgical replacement of the lens and its centration, all listed aberrations are significantly reduced, however, they still remain increased compared to the normal values.