Marfan syndrome (MFS) is a genetic disorder that affects the connective tissue in several systems, with ocular, cardiovascular, and skeletal system manifestations. Its ocular manifestations include ectopia lentis (EL), myopia, astigmatism, and corneal abnormalities. This review examines refractive alterations related to MFS such as EL, microspherophakia, lens coloboma, altered corneal biomechanics (flattening, thinning, and astigmatism), and myopia and their impact on visual acuity. The pathogenesis of these manifestations stems from mutations in the FBN1 gene (encoding fibrillin-1). Moreover, the current medical and surgical management strategies for MFS-related refractive errors, including optical correction (eyeglasses, contact lenses, etc.), and surgical interventions like lensectomy, intraocular lens (IOL) implantation (anterior chamber, posterior chamber, scleral-fixated, iris-fixated), and the use of capsular tension rings/segments are further discussed. Considering the likelihood of underdiagnosing and underestimating ocular involvement in MFS, this updated review highlights the critical need to identify and address these refractive issues to enhance the visual outcomes for those affected.

To report a case of allogeneic anterior lens capsule transplantation (ALCT) for the management of HSV neurotrophic epithelial keratitis. An 81-year-old man was referred to our department due to neurotrophic keratitis in the left eye that he had been suffering from over the past 3 months. He had recurrent episodes of HSV keratitis in the left eye over the past 3 years and despite multiple previous treatments, there was no improvement. At the time of presentation, corrected distance visual acuity (CDVA) was 20/200 in the right eye and no light perception (NLP) in the left eye. Slit-lamp examination revealed a corneal epithelial defect with underlying stromal thinning and concomitant scarring. An allogeneic anterior lens capsule (ALC) was placed over the epithelial defect to act as a biological dressing, anchored with a droplet of fibrin glue. A bandage contact lens (BCL) was placed over to prevent the slippage of the ALC. No intra or postoperative complications were observed. Two weeks later, the ALC was removed revealing complete epithelial healing, while two months later the epithelium remained completely healed with a significant reduction of corneal scarring. Anterior Lens Capsule transplantation (ALCT) seems to be a promising new treatment option for the management of corneal neurotrophic keratitis.

Introduction: The FIL SSF intraocular lens (IOL) (Carlevale, Soleko, Italy) is a sutureless scleral-fixated lens designed for cases of aphakia with insufficient capsular support. While generally stable, intraoperative complications such as haptic rupture may occur. We present a novel rescue technique for scleral fixation of FIL SSF IOL following rupture of the trans-scleral plug during combined penetrating keratoplasty, three-port pars plana vitrectomy, and IOL implantation. Case Presentation: During the combined procedure, rupture of one FIL SSF IOL plug was identified. The compromised haptic was externalized into the subconjunctival space. The sclerotomy was sutured to secure the haptic, achieving both immobilization and stable positioning of the IOL. Postoperatively, the patient was followed for 6 months. Best corrected visual acuity reached 0.2 (decimal scale), intraocular pressure was stable at 14 mm Hg in the left eye, the corneal graft remained clear, and the FIL SSF IOL maintained centration without further complications. Conclusion: This case demonstrates that intraoperative rupture of the FIL SSF IOL haptic can be effectively managed using a scleral anchoring technique. This approach provides a stable and safe alternative for salvaging IOL fixation during complex anterior and posterior segment surgeries.