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Anterior segment reconstruction with artificial iris and Descemet membrane endothelial keratoplasty: a staged surgical approach
  1. Marcus Ang1,2,3,
  2. Donald Tan1,2,3
  1. 1Singapore National Eye Centre, Singapore
  2. 2Singapore Eye Research Institute, Singapore
  3. 3Ophthalmology and Visual Sciences, Duke – NUS Graduate Medical School, Singapore
  1. Correspondence to Professor Donald Tan, Singapore National Eye Centre, Singapore, Singapore; donald.tan.t.h{at}


Purpose To describe a surgical approach that involves anterior segment reconstruction with CustomFlex Artificial Iris (CAI; HumanOptics, Erlangen, Germany) followed by Descemet membrane endothelial keratoplasty (DMEK) in complex eyes with corneal decompensation.

Methods Restrospective case series of eyes that underwent anterior segment restoration involving (1) synechiolysis of peripheral anterior synechiae and excision of iris remnants, (2) securing a well-fixated posterior chamber intraocular lens and (3) suture-fixated or capsular bag placement of CAI. All eyes then underwent DMEK using a pull-through technique with the DMEK EndoGlide (Network Medical Products, Ripon, UK). Main outcomes were successful anterior segment restoration and corneal clarity with central corneal thickness (CCT).

Results Five eyes of five patients (median age 61 years, range 27–69 years; 60% female) underwent anterior segment reconstruction with CAI implantation (4 suture-fixated), followed by successful DMEK surgery (median 2 months later, range 1–5 months). There were no major intraoperative complications or primary graft failure, with one peripheral graft detachment that underwent a successful re-bubble at 1 week. All eyes had stable CAI implants and DMEK grafts remained clear at last follow-up with reduction in mean central corneal thickness (preoperative: 658±86 µm vs postoperative: 470±33 µm, p=0.005).

Conclusion This pilot study highlights a feasible approach of initial anterior segment reconstruction with CAI implantation, prior to DMEK, in eyes with significant anterior segment abnormalities such as iris damage or extensive peripheral anterior synechiae and corneal decompensation.

  • angle
  • anterior chamber
  • cornea
  • iris

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  • Collaborators None.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests DT is an inventor of the DMEK Endoglide.

  • Patient consent for publication Not required.

  • Ethics approval This study was performed with approval from the Singapore Health Services Ethics and Institutional Review Board (CIRB Ref 2011/577/A) conforming to the tenets of the Declaration of Helsinki, and informed consent was obtained from all patients.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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