case_images: PMC4081653_01
case_images: DMEK surgery with pre-existing scleral sutured IOL. A, Preoperative status demonstrating secondary corneal edema due to bullous keratopathy because of an anterior chamber IOL. B, Diffuse corneal edema and a stable, well-positioned, scleral-fixated IOL after explantation of the anterior chamber IOL. C, Appearance 3 months after DMEK surgery, showing a clear cornea with a well-centered and well-attached graft and unchanged position of the IOL.
case_images: 1471-2415-14-6-1.jpg
case_images: PMC4081653_01_1471-2415-14-6-1.jpg
case_images: F1
case_images: Anterior segment examination showed diffuse corneal edema, descemet membrane folds and an anterior chamber IOL (Figure  1A). 20 years earlier, she had a bilateral cataract extraction with an anterior chamber IOL implantation. Anterior segment examination showed diffuse corneal edema and a stable, well-positioned, scleral-fixated IOL (Figure  1B). The cornea was clear with a well-centered and well-attached graft, and the scleral-fixated IOL was in place and well-centred (Figure  1C).
case_images: PMC4081653_02
case_images: DMEK surgery with pre-existing iris-sutured IOL. A, Preoperative status demonstrating secondary corneal edema due to bullous keratopathy because of an anterior chamber IOL and showing surgical peripheral iridectomy at 12 o'clock. B, Diffuse corneal edema and a stable, well-positioned, Artisan iris-fixated IOL after explantation of the anterior chamber IOL. C, Appearance 3 months after DMEK surgery, showing a clear cornea with a well-centered and well-attached graft and unchanged position of the IOL.
case_images: 1471-2415-14-6-2.jpg
case_images: PMC4081653_02_1471-2415-14-6-2.jpg
case_images: F2
case_images: IOL in her right eye was referred to our institution. In November 2010 at the time of presentation anterior segement examination showed diffuse corneal edema, a well-positioned anterior chamber IOL and a surgical peripheral iridectomy at 12 o'clock (Figure  2A). During a follow-up of a year, bullous keratopathy developed, causing a decrease in BCVA from 20/160 to counting fingers at 1 meter (Figure  2B). BCVA had improved by 3 months to 20/100 (Figure  2C).