{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T10:06:43Z","timestamp":1775642803408,"version":"3.50.1"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/deed.de"},{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/deed.de"}],"funder":[{"name":"Universit\u00e4tsklinikum des Saarlandes und Medizinische Fakult\u00e4t der Universit\u00e4t des Saarlandes"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ophthalmologie"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Indikationen<\/jats:title>\n                    <jats:p>Ziel der etagenweisen Revision ist eine einzeitige, idealerweise definitive chirurgische Therapie der Vorderkammerlinsen-bedingten Hornhaut-Endothel-Epithel-Dekompensation (HEED) und bull\u00f6ser Keratopathie mittels Intraokularlinsen(IOL)-Explantation, Pars-plana-Vitrektomie, sekund\u00e4rer IOL-Implantation und simultaner \u201eDescemet membrane endothelial keratoplasty\u201c (DMEK). Voraussetzung f\u00fcr eine derartige Operation ist die Abwesenheit von pr\u00e4descemetalen kornealen Narben.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Operationstechnik<\/jats:title>\n                    <jats:p>F\u00fcr eine vollst\u00e4ndige Mobilisation der subluxierten Vorderkammer-Iris-Claw-IOL werden die Haptiken durchtrennt, und die Linse wird durch einen 6\u202fmm breiten, kranialen sklerokornealen Tunnel entfernt. Bei stattgehabter Kapselruptur (extern) erfolgte eine vordere und hintere 25-Gauge-Vitrektomie einschlie\u00dflich aktiver hinterer Glask\u00f6rperabhebung. Nach manueller Irisdehnung zur bestm\u00f6glichen Rekonstruktion von Iris und Pupille wird eine Iris-Claw-IOL retroiridal enklaviert. Abschlie\u00dfend erfolgt eine DMEK mit Transplantatdurchmesser von 7,5\u202fmm von temporal zur Therapie der Hornhautdekompensation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Schlussfolgerungen<\/jats:title>\n                    <jats:p>Bei Patienten mit Hornhaut-Endothel-Epithel-Dekompensation und bull\u00f6ser Keratopathie durch eine (sub)luxierte Vorderkammer-IOL ist die IOL-Explantation mit kompletter Vitrektomie, sekund\u00e4rer Implantation einer retroiridal irisfixierten IOL und kombinierter DMEK eine effektive, einzeitige chirurgische Therapieoption.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Video online<\/jats:title>\n                    <jats:p>Die Online-Version dieses Beitrags enth\u00e4lt ein Video.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00347-026-02396-x","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T14:48:59Z","timestamp":1770389339000},"page":"282-287","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Etagenweise Revision nach komplizierter Kataraktchirurgie. Video-Beitrag","Multilevel revision after complicated cataract surgery. Video article"],"prefix":"10.1007","volume":"123","author":[{"given":"Paul","family":"Teping","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Berthold","family":"Seitz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Loay","family":"Daas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,2,6]]},"reference":[{"key":"2396_CR1","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1177\/11206721231187921","volume":"34","author":"F Alio","year":"2024","unstructured":"Alio\u00a0F, Barraquer\u00a0R, Canto-Cerdan\u00a0M et\u00a0al (2024) Causes of intraocular pseudophakic lens explantation in Spain. Eur J Ophthalmol 34:432\u2013439","journal-title":"Eur J Ophthalmol"},{"key":"2396_CR2","doi-asserted-by":"publisher","first-page":"922","DOI":"10.1016\/j.ajo.2010.01.005","volume":"149","author":"BO Bachmann","year":"2010","unstructured":"Bachmann\u00a0BO, Laaser\u00a0K, Cursiefen\u00a0C et\u00a0al (2010) A method to confirm correct orientation of descemet membrane during descemet membrane endothelial keratoplasty. Am J Ophthalmol 149:922\u2013925","journal-title":"Am J Ophthalmol"},{"key":"2396_CR3","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1097\/ICO.0000000000001111","volume":"36","author":"L Baydoun","year":"2017","unstructured":"Baydoun\u00a0L, Muller\u00a0T, Lavy\u00a0I et\u00a0al (2017) Ten-Year Clinical Outcome of the First Patient Undergoing Descemet Membrane Endothelial Keratoplasty. Cornea 36:379\u2013381","journal-title":"Cornea"},{"key":"2396_CR4","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1007\/s10792-015-0117-z","volume":"36","author":"V Bhandari","year":"2016","unstructured":"Bhandari\u00a0V, Reddy\u00a0JK, Siddharthan\u00a0KS et\u00a0al (2016) Simultaneous Descemet\u2019s membrane endothelial keratoplasty and posterior iris-claw-fixated intra ocular lens implantation (IOL) in management of aphakic bullous keratopathy. Int Ophthalmol 36:305\u2013311","journal-title":"Int Ophthalmol"},{"key":"2396_CR5","volume":"10","author":"S Feizi","year":"2018","unstructured":"Feizi\u00a0S (2018) Corneal endothelial cell dysfunction: etiologies and management. Ther Adv Ophthalmol 10:2515841418815802","journal-title":"Ther Adv Ophthalmol"},{"key":"2396_CR6","doi-asserted-by":"publisher","first-page":"646","DOI":"10.1136\/bjo-2022-323162","volume":"108","author":"E Flockerzi","year":"2024","unstructured":"Flockerzi\u00a0E, Turner\u00a0C, Seitz\u00a0B et\u00a0al (2024) Descemet\u2019s membrane endothelial keratoplasty is the predominant keratoplasty procedure in Germany since 2016: a\u00a0report of the DOG-section cornea and its keratoplasty registry. Br J Ophthalmol 108:646\u2013653","journal-title":"Br J Ophthalmol"},{"key":"2396_CR7","doi-asserted-by":"publisher","first-page":"1291","DOI":"10.1136\/bjophthalmol-2014-304948","volume":"98","author":"J Gonnermann","year":"2014","unstructured":"Gonnermann\u00a0J, Maier\u00a0AK, Klamann\u00a0MK et\u00a0al (2014) Posterior iris-claw aphakic intraocular lens implantation and Descemet membrane endothelial keratoplasty. Br J Ophthalmol 98:1291\u20131295","journal-title":"Br J Ophthalmol"},{"key":"2396_CR8","doi-asserted-by":"publisher","first-page":"1347","DOI":"10.1097\/ICO.0000000000001677","volume":"37","author":"S Heinzelmann","year":"2018","unstructured":"Heinzelmann\u00a0S, Bohringer\u00a0D, Haverkamp\u00a0C et\u00a0al (2018) Influence of Postoperative Intraocular Pressure on Graft Detachment After Descemet Membrane Endothelial Keratoplasty. Cornea 37:1347\u20131350","journal-title":"Cornea"},{"key":"2396_CR9","doi-asserted-by":"publisher","first-page":"1362","DOI":"10.1016\/j.jcrs.2003.08.015","volume":"30","author":"RS Hoffman","year":"2004","unstructured":"Hoffman\u00a0RS, Fine\u00a0IH, Packer\u00a0M (2004) Retained IOL fragment and corneal decompensation after pseudophakic IOL exchange. J\u00a0Cataract Refract Surg 30:1362\u20131365","journal-title":"J Cataract Refract Surg"},{"key":"2396_CR10","doi-asserted-by":"publisher","first-page":"2761","DOI":"10.1007\/s00417-020-04928-w","volume":"258","author":"T Huang","year":"2020","unstructured":"Huang\u00a0T, Wu\u00a0J, Dong\u00a0X et\u00a0al (2020) Descemet membrane endothelial keratoplasty for corneal decompensation caused by a\u00a0phakic anterior chamber intraocular lens implantation. Graefes Arch Clin Exp Ophthalmol 258:2761\u20132766","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"2396_CR11","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1016\/j.jcrs.2010.11.021","volume":"37","author":"F Karimian","year":"2011","unstructured":"Karimian\u00a0F, Sadoughi\u00a0MM (2011) Air-assisted Descemet-stripping automated endothelial keratoplasty with posterior chamber iris-fixation of aphakic iris-claw intraocular lens. J\u00a0Cataract Refract Surg 37:224\u2013228","journal-title":"J Cataract Refract Surg"},{"key":"2396_CR12","doi-asserted-by":"publisher","first-page":"1115","DOI":"10.1097\/ICO.0000000000003531","volume":"43","author":"M Menkene L","year":"2024","unstructured":"Menkene L\u00a0M, Berger\u00a0T, Safi\u00a0T et\u00a0al (2024) Analysis of Graft Detachments and Re-Bubblings After 450 Descemet Membrane Endothelial Keratoplasty Procedures. Cornea 43:1115\u20131123","journal-title":"Cornea"},{"key":"2396_CR13","doi-asserted-by":"publisher","first-page":"NP13","DOI":"10.1177\/11206721231213684","volume":"34","author":"B Mergen","year":"2024","unstructured":"Mergen\u00a0B, Berger\u00a0T, Hamon\u00a0L et\u00a0al (2024) Anterior chamber intraocular lens removal combined with triple DMEK: Quadruple DMEK for bullous keratopathy. Eur J Ophthalmol 34:NP13\u2013NP17","journal-title":"Eur J Ophthalmol"},{"key":"2396_CR14","doi-asserted-by":"publisher","first-page":"1253","DOI":"10.1097\/ICO.0000000000002723","volume":"40","author":"I Moshiri","year":"2021","unstructured":"Moshiri\u00a0I, Karimi-Golkar\u00a0D, Schrittenlocher\u00a0S et\u00a0al (2021) Outcomes of Pseudophakic, Phakic, and Triple DMEK. Cornea 40:1253\u20131257","journal-title":"Cornea"},{"key":"2396_CR15","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1007\/s00347-014-3121-1","volume":"112","author":"I Schmidt","year":"2015","unstructured":"Schmidt\u00a0I, Langenbucher\u00a0A, Moussa\u00a0S et\u00a0al (2015) Retroiridal implantation of a\u00a0Verisyse iris claw lens: refractive outcome and individualized intraocular lens constants. Ophthalmologe 112:261\u2013265","journal-title":"Ophthalmologe"},{"key":"2396_CR16","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1007\/s00347-020-01134-1","volume":"117","author":"B Seitz","year":"2020","unstructured":"Seitz\u00a0B, Daas\u00a0L, Flockerzi\u00a0E et\u00a0al (2020) Descemet membrane endothelial keratoplasty DMEK - Donor and recipient step by step. Ophthalmologe 117:811\u2013828","journal-title":"Ophthalmologe"},{"key":"2396_CR17","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0267940","volume":"17","author":"A Semler-Collery","year":"2022","unstructured":"Semler-Collery\u00a0A, Bloch\u00a0F, Hayek\u00a0G et\u00a0al (2022) Comparison of triple-DMEK to pseudophakic-DMEK: A cohort study of 95 eyes. PLoS One 17:e0267940","journal-title":"PLoS One"},{"key":"2396_CR18","volume":"2020","author":"Y Tang","year":"2020","unstructured":"Tang\u00a0Y, Xu\u00a0J, Chen\u00a0J et\u00a0al (2020) Long-Term Destiny of Corneal Endothelial Cells in Anterior Chamber Intraocular Lens-Implanted Eyes. J\u00a0Ophthalmol 2020:5967509","journal-title":"J Ophthalmol"},{"key":"2396_CR19","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1097\/ICO.0b013e3182a9dffb","volume":"33","author":"FM Velez","year":"2014","unstructured":"Velez\u00a0FM, Mannis\u00a0MJ, Izquierdo\u00a0L Jr. et\u00a0al (2014) Simultaneous surgery for corneal edema and aphakia: DSEK and placement of a retropupillary iris claw lens. Cornea 33:197\u2013200","journal-title":"Cornea"}],"container-title":["Die Ophthalmologie"],"original-title":[],"language":"de","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00347-026-02396-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00347-026-02396-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00347-026-02396-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T09:30:18Z","timestamp":1775640618000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00347-026-02396-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,6]]},"references-count":19,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["2396"],"URL":"https:\/\/doi.org\/10.1007\/s00347-026-02396-x","relation":{},"ISSN":["2731-720X","2731-7218"],"issn-type":[{"value":"2731-720X","type":"print"},{"value":"2731-7218","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,6]]},"assertion":[{"value":"25 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Einhaltung ethischer Richtlinien"}},{"value":"P.\u00a0Teping, B.\u00a0Seitz und L.\u00a0Daas geben an, dass kein Interessenkonflikt besteht.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Interessenkonflikt"}},{"value":"F\u00fcr diesen Beitrag wurden von den Autor\/-innen keine Studien an Menschen oder Tieren durchgef\u00fchrt. F\u00fcr die aufgef\u00fchrten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Interessenkonflikt"}}]}}