Phakic intraocular lens as a temporary barrier in aphakic Descemet’s membrane endothelial keratoplasty

Abstract

Background: Descemet’s membrane endothelial keratoplasty has a lower risk of endothelial rejection than Descemet’s stripping automated endothelial keratoplasty. In aphakic eyes requiring endothelial transplantation, approaches aimed at reducing the risk of posterior graft dislocation in Descemet’s stripping automated endothelial keratoplasty are not transferable to Descemet’s membrane endothelial keratoplasty. Technique: Here we describe the use of an implantable collamer lens placed over the iris to provide a temporary intraoperative platform, to facilitate graft unfolding and to avoid posterior graft dislocation in an aphakic, vitrectomised eye with a fixed, dilated pupil in a young patient with chronic uveitis and previous failed Descemet’s stripping automated endothelial keratoplasty.

Temporary iris-lens diaphragm to assist descemet membrane endothelial keratoplasty in aphakic patients

“… 20 Another group proposed inserting an ICL over the iris to create a temporary intraoperative barrier, facilitate graft deployment, and prevent posterior graft dislocation. 21 …”

“The Spinning Technique” for Unfolding Tightly Scrolled DMEK Grafts

“…DMEK indications are expanding, and as in our series, it can be cautiously performed in complex anterior segment pathologies, including glaucoma drainage devices, ACIOLs, or even aphakic eyes. [21][22][23] We decided to perform DMEK in such cases because in our experience, graft survival in these eyes has better long-term outcomes than DSAEK, presumably due to its lower risk of rejection. 2,4 This is important to consider in eyes such as our fourth patient with a history of chronic uveitis and 2 glaucoma tubes who presented with 2 previously failed DSAEKs, both with less than 1-year survival.…”

Descemet membrane endothelial keratoplasty in complex eyes

“…Other creative techniques have also been reported, including a polymethyl methacrylate (PMMA) diaphragm to create an artificial double anterior chamber which supports unfolding [24] or a phakic anterior chamber IOL as a temporary pupil barrier in aphakic eyes [29]. Hayashi et al www.co-ophthalmology.com trialed a 'double-bubble' technique (small bubble anterior to the graft and a larger bubble posterior to the graft after its insertion).…”