Endoart: Artificial Endothelial Keratoplasty For Failed Dmek In Ice Syndrome

To present the case of a patient with ICE syndrome, glaucoma with a drainage device, and failed DMEK, treated with EndoArt implantation, and to describe her anatomical and functional outcomes.

Cornea department. Hospital Universitario Virgen de las Nieves. Granada

A 50-year-old woman with ICE syndrome of the essential iris atrophy subtype in the right eye, secondary glaucoma treated with a Paul valve, cataract surgery with monofocal IOL implantation, and failed DMEK due to uncontrolled ocular hypertension. She presented with chronic pain and visual loss in the right eye (VA OD: light perception; OS: 20/20). Examination revealed iris atrophy with multiple stromal defects, grade 2 corneal edema with epithelial microbullae, fibrosis of the DMEK graft, and a pachymetry of 1013 µm; IOP was 20 mmHg under hypotensive treatment with timolol and dorzolamide. EndoArt implantation in the right eye was indicated.

Postoperatively, corneal transparency was restored, with a significant reduction in edema (pachymetry 569 µm) and improvement in VA to 20/200. IOP stabilized at 14 mmHg with a functioning valve device and hypotensive therapy with timolol and dorzolamide. The anatomical and functional outcomes were satisfactory.

In patients with ICE syndrome and endothelial failure after DMEK in a complex anterior segment, EndoArt implantation represents a viable option to restore corneal transparency and improve visual function. This approach may be particularly considered in eyes at high risk of failure of repeat endothelial grafts due to anatomical alterations or the presence of drainage devices.