Air-Assisted Descemet Stripping Automated Endothelial Keratoplasty with Posterior Chamber Fixation of an Aphakic Iris-Claw Lens

Endothelial keratoplasty (EK) is the most exciting recent development in corneal transplantation. It has experienced surprisingly rapid growth in a very short period of time. One of the indications for EK is pseudophakic bullous keratopathy. However, concomitant intraocular lens (IOL) exchange, if indicated, may prove challenging. Some surgeons routinely perform IOL exchange with a scleral-fixated posterior chamber IOL, together with Descemet's stripping endothelial keratoplasty (DSEK); however, this combined procedure is time-consuming, difficult and fraught with complications. Another option is aphakic Artisan IOL fixation, but this is usually not acceptable because of the increased risk of endothelial cell loss and difficulty in filling the anterior chamber with the air bubble. Herein, we introduce a new technique for IOL exchange with an aphakic Artisan IOL fixated posterior to the iris, combined with DSEK. This surgical technique was designed to preserve anterior segment anatomic features as much as possible.