Anterior chamber intraocular lens removal combined with triple DMEK: Quadruple DMEK for bullous keratopathy

Purpose To present the outcomes of a patient with anterior chamber intraocular lens (ACIOL) related endothelial decompensation who underwent Descemet membrane endothelial keratoplasty (DMEK) and cataract surgery with intraocular lens (IOL) implantation in the capsular bag (so-called tripleDMEK) combined with ACIOL removal (quadrupleDMEK) in both eyes.Methods Case reportResults A 58-year-old female patient was referred due to decreased visual acuity within the last 18 months. She had a history of iris-claw ACIOL implantation 17 years before. The corrected distance visual acuity (CDVA) was 20/40 in both eyes. Due to low endothelial cell density and increased corneal thickness, ACIOL removal combined with tripleDMEK (as quadrupleDMEK) was performed for both eyes. Despite a graft detachment that was successfully managed with re-bubbling in the first eye, both eyes showed an increase in the CDVA (20/25 and 20/32, respectively) without any other significant complications in the follow-up of the patient. The corneas of both eyes were clear postoperatively.Conclusion This case report demonstrated that quadrupleDMEK may provide feasible management for chronic endothelial cell decompensation secondary to iris-claw ACIOL implantation.