Artificial corneal implant in iridocorneal endothelial syndrome with secondary glaucoma: case report

Introduction: To describe the first case, to the authors' knowledge, of KeraKlear artificial corneal implant, assisted by a Carl Zeiss femtosecond laser, in iridocorneal endothelial (ICE) syndrome with secondary glaucoma. Patient and Clinical Findings: A 66-year-old woman with known ICE syndrome and secondary glaucoma in her right eye, using long-term glaucoma eyedrops (Xalacom, Simbrinza), presented with a 3-year history of progressive blurred vision in the right eye associated with a slowly enlarging whitish subepithelial fibrotic membrane from the temporal cornea, with corrected distance visual acuity deteriorating from 0.8 to 0.1 (Snellen). The fibrotic membrane is a subepithelial scar secondary to chronic corneal edema involving the temporal and central cornea. Diagnosis, Intervention, and Outcomes: A femtosecond laser-assisted KeraKlear artificial cornea implantation was performed in the patient's right eye. After 3 months, the KeraKlear prosthetic cornea remained stable with no signs of extrusion or periprosthetic corneal thinning. Corrected distance visual acuity was improved to 0.3 (Snellen), and the endothelial cell counts remained stable at around 2700 cell/mm 2 (vs 2800 in the left eye). Conclusions: Penetrating and endothelial keratoplasties carry a high risk for failure in ICE syndrome, especially in the setting of glaucoma. The KeraKlear was a useful alternative to keratoplasty in this setting, and unlike keratoplasty has not been shown to worsen glaucoma.