[Multilevel revision after complicated cataract surgery. Video article].

Area of Science:

• Ophthalmology
• Corneal Surgery
• Intraocular Lens Implantation

Background:

• Corneal endothelial decompensation and bullous keratopathy can result from dislocated anterior chamber iris claw intraocular lenses (IOLs).
• Current management often involves multiple surgical stages, increasing patient burden and risk.

Purpose of the Study:

• To evaluate the efficacy of a single-stage surgical revision for corneal decompensation secondary to iris claw IOL complications.
• To describe a novel surgical technique combining IOL explantation, vitrectomy, secondary IOL implantation, and Descemet membrane endothelial keratoplasty (DMEK).

Main Methods:

• A multi-stage surgical approach was employed, including IOL explantation via a sclerocorneal tunnel, complete pars plana vitrectomy, and secondary retroiridal iris claw IOL implantation.
• Simultaneous Descemet membrane endothelial keratoplasty (DMEK) was performed using a 7.5 mm donor graft via temporal access.
• The prerequisite for this procedure is the absence of pre-Descemet corneal scars.

Main Results:

• The described single-stage procedure effectively treats corneal endothelial decompensation and bullous keratopathy associated with dislocated iris claw IOLs.
• This combined approach offers a definitive solution in a single operative session.

Conclusions:

• IOL explantation combined with complete vitrectomy, secondary retroiridal iris-fixated IOL implantation, and DMEK is an effective and efficient single-stage treatment.
• This surgical strategy provides a viable option for managing complex cases of IOL-induced corneal pathology.