NEUROTROPHIC KERATOPATHY IN MARFAN SYNDROME PATIENT AFTER MICROPULSE TRANSSCLERAL CYCLOPHOTOCOAGULATION: A CALL FOR RISK STRATIFICATION

This report seeks to shed light on a potential high-risk subgroup susceptible to neurotrophic keratopathy, exemplified by our patient with Marfan syndrome, a condition characterized by thin sclera.

Tertiary eye care hospital in Riyadh, Saudi Arabia.

A 47-year-old man known to have Marfan syndrome with pseudophakic glaucoma, underwent micropulse transscleral cyclophotocoagulation due to uncontrolled glaucoma bilaterally followed by an acute presentation of neurotrophic keratopathy in both eyes postoperatively. Supportive management was initiated including topical antibiotics, preservative-free lubrication, medroxyprogesterone acetate 1%, serum balanced salt solution (BSS) 50%, and the application of bandage contact lenses to expedite healing. Fortunately, the left eye demonstrated resolution within 10 days, while the right eye exhibited delayed healing, leading to subsequent scarring.

This report highlights the critical importance of recognizing populations predisposed to neurotrophic keratopathy before subjecting them to micropulse transscleral cyclophotocoagulation. Such awareness allows for the fine-tuning of procedural parameters, offering a strategic approach to mitigate the risk of neurotrophic keratopathy development. By further exploring and recognizing potential risk factors, clinicians can enhance patient outcomes and refine the safety profile of micropulse transscleral cyclophotocoagulation.