This study reports the distribution of SD-OCT data for patients with Marfan syndrome. Compared to a normative database, 18% of eyes with Marfan syndrome had RNFL thickness < 5% of the population.

A healthy infant girl presented with bilateral 1-mm anterior polar cataracts. Initial monitoring every 2 to 3 months was recommended, but she did not return until she was 16 months old, at which point the cataracts had prominent pyramidal growth with a significant cortical component (Figure). Her visual acuity was 0.64 cycle/cm OD using Teller acuity cards, and she would only fix and follow OS. The remainder of her examination was unremarkable, including B-scan ultrasonography of the posterior segment. She underwent lensectomy/anterior vitrectomy in each eye and used aphakic con-tact lenses. She was 3 years old at her last visit and had inconsistent follow-up and poor compliance with amblyopia management. Her visual acuity was 20/60 OD and 20/250 OS, complicated by a sensory left esotropia.Anterior pyramidal cataracts have been reported as unilateral or bilateral presentations at birth but may progress from typical polar opacities. There are no systemic associations. 1-3 Rarely, a spontaneous dehiscence of the pyramid into the anterior chamber may occur. 4,5

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