“Unexpected athalamia after scleral buckling for retinal detachment in a pediatric Marfan patient with scleral-fixated intraocular lens”

PURPOSE: To report the clinical course and management of a rare complication after scleral buckling for rhegmatogenous retinal detachment (RRD) in a pediatric Marfan patient with a scleral-fixated intraocular lens (SFIOL). We describe complete anterior chamber collapse with diffuse iridocorneal contact (athalamia), its mechanism, and treatment. METHODS: A 14-year-old boy with Marfan syndrome, functionally monocular due to phthisis in the fellow eye, presented with a macula-off inferior RRD with a stiff retinal surface, pigmented clumps, and suspected microholes, without visible breaks or proliferative vitreoretinopathy. At age five, he had undergone bilateral lens extraction, core vitrectomy, and SFIOL implantation. A 360° scleral buckle was performed using the D-ACE sequence (Drainage-Air-Cryotherapy-Explant). RESULTS: Three day after surgery, complete athalamia developed without wound leak, choroidal detachment, or ocular hypertension. Optical coeherence tomography (OCT) showed posterior iris apposition and loss of SFIOL plate, suggesting air entrapment between iris, IOL, and residual vitreous. Emergency surgery with viscoelastic injection and aspiration of trapped air restored chamber depth. Transient hypotony and corneal edema resolved in two days. CONCLUSION: Air entrapment after scleral buckling may cause athalamia without hypertension, especially in Marfan eyes with SFIOL. Early recognition of the underlying mechanism is critical to preserve vision.