Courtney CoulterMarfan Syndrome
Courtney Coulter
Ophthalmic Medical Technology Student
UAMS, Little Rock, AR
Case:
An 18-‐year-‐old white female presented to clinic for an ocular evaluation. The patient has a past medical history of Marfan syndrome with the presence of a dilated aorta. The patient had had cataract surgery ten years prior with sutured intraocular lenses placed in both eyes. However, the lens in the left eye became displaced after surgery and had to be removed from the vitreous, leaving the patient aphakic, without a lens. The patient was interested in trying to regain vision in the left eye.
Upon examination, the patient had a visual acuity of 20/20-‐2 in the right eye while wearing a contact lens. In the left eye, the patient had a visual acuity of count fingers at four feet without correction and 20/100+1 while wearing her glasses with the prescription of +9.00+1.00×064. Pupils, motility, muscle balance, confrontational visual field, and intraocular pressure were all within normal limits. A dilated exam showed a posterior chamber intraocular lens sutured in the right eye and aphakia in the left eye. The macula in the left eye showed pigment mottling, or yellow deposits around the macula4, and the peripheral retina showed 360 degrees of laser scars in the left eye. These findings led to the diagnosis of maculopathy in the left eye with a potential visual acuity of 20/100. The patient had an A-‐scan performed and was found to have an axial length of 24.59 mm in the right eye and 24.57 mm in the left eye. The patient was then scheduled for the placement of an anterior chamber intraocular lens in the left eye.
On post-‐operative day #1, the patient had a visual acuity of hand motion and an intraocular pressure of 12 mm HG with tonopen OS. The patient was also noted to have a small, layered hyphema or blood in the anterior chamber.4 On the two-‐week post-‐operative follow up, the patient’s vision had improved to 20/200, and the hyphema had resolved.