Temporary Bandage Contact Lens As An Iris Barrier For Dmek In Complex Eyes: A Case Series

Published 2026 - 44th Congress of the ESCRS

Reference: FP22.10 | Type: Free paper | DOI: 10.82333/j4yx-ap07

Authors: Chang Liu* ¹ , Qing Zhang ¹ , Lin Zhao ¹ , Zexia Dou ¹ , Jie Bai ¹ , Ling Li ¹ , Shaowei Li ¹

¹Beijing Aier-Intech Eye Hospital,Beijing ,China

Purpose

Descemet membrane endothelial keratoplasty (DMEK) in complex eyes—such as those with aphakia, vitrectomy, or iris defects—poses significant challenges due to the absence of iris-lens diaphragm support. This instability increases the risk of graft dislocation into the vitreous cavity and compromises anterior chamber control. This study evaluates the clinical efficacy of using a temporary bandage contact lens (BCL) as an artificial iris barrier to facilitate DMEK in challenging cases.

Setting

This retrospective case series was conducted at Beijing Aier-Intech Eye Hospital, China.

Methods

We retrospectively reviewed 8 patients (8 eyes) who underwent DMEK with temporary BCL implantation between June 2025 and January 2026. All patients had aphakia or a history of vitrectomy, resulting in an absent iris-lens diaphragm and poor intraoperative anterior chamber stability. During surgery, an appropriately sized BCL was placed over the iris and pupil to create a stable barrier. Outcome measures included graft attachment, intraoperative complications, and postoperative adverse events.

Results

Eight patients (mean age 59 years) were included. Preoperative lens status: 3 aphakic eyes and 5 pseudophakic eyes. Five patients had a history of vitrectomy , and 4 had iris abnormalities (including one artificial iris). Graft diameter ranged from 7.75 to 8.5 mm, and BCL from 9.0 to 10.0 mm. In 3 cases, the BCL was removed 10 minutes after graft insertion; in the remaining 5 cases, it was removed 4–6 days postoperatively. One patient experienced intraoperative graft dislocation into the vitreous, managed by graft retrieval and replacement with a larger BCL. Postoperative rebubbling for graft detachment was required in 3 patients. At 1-month follow-up, all grafts remained well-attached with no complications.

Conclusions

Temporary placement of a bandage contact lens over the iris provides a simple, effective, and safe barrier technique for DMEK in complex eyes with insufficient posterior support. This approach enhances anterior chamber stability, prevents intraoperative graft dislocation, and contributes to favorable surgical outcomes.