title: Endothelial keratoplasty for bullous keratopathy in eyes with an anterior chamber intraocular lens.
abstract: OBJECTIVE
  To describe how to approach eyes with phakic or pseudophakic bullous keratopathy that have an anterior chamber intraocular lens (AC IOL) using thin Descemet-stripping endothelial keratoplasty (thin-DSEK) or Descemet membrane endothelial keratoplasty (DMEK) with or without AC IOL removal.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Comparative case series.
  
  
  METHODS
  Descemet membrane endothelial keratoplasty or thin-DSEK was performed in pseudophakic eyes with iris-claw AC IOLs (Group 1) or in phakic eyes with angle-supported AC IOLs (Group 2). In both groups, DMEK was routinely performed except in eyes with insufficient corneal transparency or a high risk for graft detachment. Preoperative surgical considerations, postoperative corrected distance visual acuity (CDVA), endothelial cell density, and complications were documented.
  
  
  RESULTS
  In Group 1, all AC IOLs were left in situ. In Group 2, AC IOLs were removed in 90% of cases. At 6 months, the CDVA was 20/40 (≥0.5 decimal) or better in 36% of eyes in Group 1 and 90% in Group 2. Graft detachment occurred in 20% of eyes and de novo or glaucoma exacerbation in 29%.
  
  
  CONCLUSIONS
  Bullous keratopathy treatment in eyes with an AC IOL was feasible with DMEK. Intraocular lens removal may be required if postoperative complications are anticipated, but not to facilitate surgery. Overall, the surgical approach may aim to minimize postoperative complications; that is, thin-DSEK in eyes with low visual potential and/or concomitant pathology and DMEK in eyes with a phakic AC IOL and normal visual potential.
authors.affiliation: From the Netherlands Institute for Innovative Ocular Surgery (Liarakos, Ham, Dapena, Tong, Quilendrino, Yeh, Melles), the Melles Cornea Clinic (Liarakos, Ham, Dapena, Quilendrino, Yeh, Melles), and the Amnitrans EyeBank Rotterdam (Ham, Tong, Melles), Rotterdam, The Netherlands; the Naval Hospital (Liarakos), Athens, Greece.
authors.forename: Vasilios S
authors.initials: VS
authors.lastname: Liarakos
authors.forename: Lisanne
authors.initials: L
authors.lastname: Ham
authors.forename: Isabel
authors.initials: I
authors.lastname: Dapena
authors.forename: C Maya
authors.initials: CM
authors.lastname: Tong
authors.forename: Ruth
authors.initials: R
authors.lastname: Quilendrino
authors.forename: Ru-Yin
authors.initials: RY
authors.lastname: Yeh
authors.forename: Gerrit R J
authors.initials: GR
authors.lastname: Melles
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000867:Anterior Chamber / Q000473:pathology*; D001768:Blister / Q000601:surgery*; D002452:Cell Count; D003316:Corneal Diseases / Q000601:surgery*; D003661:Decision Support Techniques; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D020878:Device Removal; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D006085:Graft Survival; D006801:Humans; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019591:Pseudophakia / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology