Descemet stripping automated endothelial keratoplasty in a case with a posteriorly fixated iris-claw intraocular lens

Purpose: To report a successful case of Descemet stripping automated endothelial keratoplasty (DSAEK) performed on a vitrectomized eye with a potentially unstable posteriorly fixated iris-claw intraocular lens (IOL).Method: A standard DSAEK procedure was performed on a 42-year-old man referred to our institution because of corneal edema occurring after repeat surgery for rhegmatogenous retinal detachment. Preoperatively, the best-corrected visual acuity was 20/200, and slit-lamp examination revealed bullous keratopathy in the presence of a posteriorly fixated iris-claw IOL.Results: Both surgery and the postoperative course were uneventful. On day 1, the graft was well centered and fully attached to the posterior corneal surface. The IOL was unchanged in its position. Subsequent follow-up showed progressive improvement in corneal clarity, with a best-corrected visual acuity (BCVA) of 20/50 at the last follow-up examination (4 months).Conclusions: This case demonstrates that DSAEK is an appropriate intervention for eyes with pseudophakic bullous keratopathy, even in the setting of eyes with posteriorly fixated iris-claw IOLs that are at risk of dislocation into the vitreous cavity.