Retinal detachment in Marfan syndrome: Surgical challenges, anatomical success, and visual outcomes – A systematic review and meta-analysis

PURPOSE: To evaluate the anatomical and functional outcomes of surgical repair for rhegmatogenous retinal detachment (RD) in patients with Marfan syndrome, where connective tissue abnormalities and ocular fragility pose unique surgical challenges. MATERIALS AND METHODS: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines (PROSPERO: CRD420251136687). PubMed, Embase, MEDLINE, Cochrane Library, and Web of Science were searched to August 2025. Eligible studies reported surgical outcomes of RD in confirmed Marfan patients. Data on anatomical success, visual outcomes, complications, tamponade use, and re-detachment were extracted and synthesized using random effects models. RESULTS: Nine studies comprising 241 eyes were included. The pooled primary anatomical success rate was 67% (95% confidence interval [CI]: 0.55–0.77), increasing to 81% (95% CI: 0.72–0.84) after multiple procedures. The re-detachment rate was 30% (95% CI: 0.24–0.37). Visual outcomes varied, with improvements linked to good baseline vision and macula-on status, while other series showed deterioration. Silicone oil was the most common tamponade, reflecting the need for long-acting support, but it was associated with secondary glaucoma and corneal decompensation. Gas tamponade was used in selected cases with less extensive disease. The mean number of surgeries per eye ranged from 1.0 to 1.4, with recurrent cases requiring multiple operations. CONCLUSION: RD repair in Marfan syndrome achieves reasonable final anatomical reattachment but carries a high risk of re-detachment, limited functional recovery, and frequent complications related to silicone oil. Tailored surgical strategies and realistic counseling are essential, and multicenter prospective studies are needed to refine management.