Combined endothelial keratoplasty and clear lens extraction for corneal decompensation in irido-corneal endothelial syndrome

A 38-year-old woman presented with corneal decompensation in left eye secondary to irido-corneal endothelial (ICE) syndrome. She underwent simultaneous Descemet's stripping endothelial keratoplasty (DSEK) and clear lens extraction with posterior chamber intraocular lens implantation. The surgery was accomplished comfortably without rupture of peripheral anterior synechiae (PAS). 5 weeks postoperatively, the graft was attached, the cornea was clear and best-corrected visual acuity improved from 20/400 to 20/30. DSEK combined with clear lens extraction appears to be an effective measure to treat corneal decompensation in patients with ICE syndrome. Associated lens extraction in such cases increases the working space in anterior chamber for DSEK, which minimizes the intra-operative graft manipulation. This also avoids a future difficult cataract surgery in the presence of PAS and an endothelial graft, which may increase the chances of graft survival.