Etagenweise Revision nach komplizierter Kataraktchirurgie. Video-Beitrag

INDICATIONS: The aim of the multilevel revision is a single-stage, ideally definitive surgical treatment of corneal-endothelial-epithelial decompensation and bullous keratopathy caused by an anterior chamber iris claw intraocular lens (IOL) by means of IOL explantation, complete pars plana vitrectomy, secondary IOL implantation and simultaneous Descemet membrane endothelial keratoplasty (DMEK). The prerequisite for surgery is the absence of pre-Descemet corneal scars. SURGICAL TECHNIQUE: For complete mobilization of the dislocated anterior chamber IOL the haptics are severed and the lens is removed through a 6 mm wide superior sclerocorneal tunnel. Complete anterior and posterior 25-gauge vitrectomy is performed including removal of the active posterior vitreous detachment. After manual iris tissue stretching, a retroiridal iris claw IOL is implanted. In the end, DMEK with a donor graft size of 7.5 mm is performed via temporal access for treatment of the corneal decompensation. CONCLUSION: In patients with corneal-endothelial-epithelial decompensation and bullous keratopathy due to a dislocated anterior chamber IOL, IOL explantation with complete vitrectomy, secondary implantation of a retroiridal, iris-fixated IOL and combined DMEK is an effective, single-stage surgical treatment. VIDEO ONLINE: The online version of this article contains a video.