Descemet membrane endothelial keratoplasty in an aphakic vitrectomized eye with a large iris defect

A 58-year old man who had a previous vitrectomy had Descemet membrane endothelial keratoplasty (DMEK) for endothelial decompensation in the right eye. He had an accompanying large iris defect and a subluxated intraocular lens, which required removal at the beginning of the surgery. Surgery was performed in the aphakic vitrectomized eye without the support of the iris in the superior quadrants. The anterior chamber was stabilized with the use of a pars plana infusion. The DMEK graft could be successfully inserted and unfolded at the stromal surface with the aid of air and infusion fluid and then attached to the recipient stroma. Three months postoperatively, the graft remained attached, the corrected distance visual acuity improved from counting fingers to 20/200, and the central corneal thickness was reduced from 1000 μm to 712 μm. This case shows that DMEK can be a feasible procedure in the absence of support of the vitreous and iris–lens diaphragm.