Abstract
PURPOSE: To report an alternative technique to implant the EndoArt using a pull-through insertion. This technique is helpful in complex eyes, especially in eyes with unstable iris lens diaphragm. OBSERVATION: We present a case of advanced pseudophakic bullous keratopathy with aniridia, previous vitrectomy, and tube implants in which the initial attempt to implant the EndoArt failed, and the device was lost to the vitreous cavity. An alternative surgical technique, a pull-through insertion, was used to implant a second device successfully. The patient was followed over a period of 1 year. Corneal edema gradually improved over time, and all epithelial bullae resolved. The central corneal thickness (CCT) decreased from 911um to 691 μm. CONCLUSION AND IMPORTANCE: EndoArt is a treatment for endothelial failure in complex eyes. In addition, the pull-through insertion technique can help improve control over the implant in very complicated eyes.