Aims To analyse the surgical outcomes and postoperative complications of 23-G lensectomy–vitrectomy in the management of ectopia lentis in patients with Marfan syndrome.

Methods This retrospective study evaluated all patients with Marfan syndrome who received 23-G lensectomy–vitrectomy either through pars plana or the limbus for management of ectopia lentis between 1 January 2008 and 31 December 2011 at Eye and ENT Hospital of Fudan University.

Results A total of 64 eyes of 39 patients with Marfan syndrome (28 males and 11 females) underwent lensectomy–vitrectomy as a primary procedure for ectopia lentis. The best-corrected visual acuity improved significantly from 0.5 (0.3–0.7) LogMar preoperatively to 0.3 (0.1–0.5) LogMar (p<0.01) at the last postoperative visit. Retinal detachment (RD) occurred in 11 eyes. Comparing the characteristics between those patients with detached and non-detached retinas, a more severe grade of lens dislocation (p=0.001) and higher axial myopia (p=0.035) were observed among those with detached retinas, whereas there were no significant differences between the two groups in terms of age (p=0.624), pseudophakia or aphakia (p=0.672), and preventive photocoagulated breaks (p=0.719). There was no significant difference in the incidence of RD between the scleral-fixated intraocular lens group and anterior chamber intraocular lens group (p=0.412).

Conclusions Development of RD in patients with Marfan syndrome remains a risk following surgery for ectopia lentis. Caution should be taken in eyes with severe lens dislocation or high axial myopia when planning the surgery.