Surgical treatment of corneal endothelial decompensation in the presence of an anterior chamber intraocular lens (AC IOL) is technically challenging. The ultimate management is to perform Descemet membrane endothelial keratoplasty (DMEK). However , unfolding the DMEK graft in the presence of an AC IOL can be difficult and injurious to the graft so the investigators recommend exchanging the AC IOL with a posterior chamber IOL first. In this study , the investigators aim to compare the outcome and complications of performing DMEK and IOL exchange as combined one stage surgery versus .sequential 2 stage procedure
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postoperative endothelial cell loss in percentage
Timeframe: 3 months
Best spectacle corrected visual acuity
Timeframe: 3 months
postoperative hyphema and and intraocular pressure spikes
Timeframe: 1month postoperatively
Postoperative AC inflammatory reactions
Timeframe: 1 month postoperatively
Postoperative intraocular pressure spikes
Timeframe: 1 month postoperatively