A novel use of temporary ICL during DMEK to prevent gas-induced opacification of a scleral-fixated Carlevale IOL.

Purpose: To report a novel surgical strategy using a temporary implantable collamer lens (ICL) during Descemet membrane endothelial keratoplasty (DMEK) to prevent gas-induced opacification of a scleral-fixated Carlevale intraocular lens (IOL) in a vitrectomized eye. Observations: A 68-year-old male with a history of blunt trauma, pars plana vitrectomy, and Carlevale IOL implantation developed irreversible corneal edema. DMEK was performed with the intraoperative placement of an inverted ICL in the anterior chamber, serving as a protective barrier between the gas tamponade and the IOL. The ICL was explanted two weeks later, without complications. The endothelial graft remained well attached throughout the follow-up period, with no intraoperative or postoperative adverse events. The optical clarity of the Carlevale IOL was preserved, and no ICL-related complications were observed. Best-corrected visual acuity (BCVA) improved from logMAR 1.00 preoperatively to logMAR 0.22 by 3 months, with stability maintained through the 6-month follow-up period. Conclusions and importance: Temporary ICL implantation during DMEK may be an effective strategy to prevent gas-induced opacification in eyes with hydrophilic IOLs. Unlike IOL exchange, which adds surgical trauma, or gas-minimizing strategies, which risk detachment, this approach preserves full tamponade while safeguarding IOL clarity.