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    General

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    Grand Rounds

    A patient presented with unilateral corneal edema, mild iris atrophy, and secondary angle-closure glaucoma consistent with Chandler syndrome. The case highlights diagnostic features, differential considerations, and therapeutic decision-making. A literature review of recent studies evaluating DMEK in ICE and phakic eyes was performed to contextualize outcomes and technical modifications. Results: Chandler syndrome is characterized by an abnormal population of endothelial cells exhibiting an epithelial-like phenotype, leading to corneal edema, peripheral anterior synechiae, and variable iris changes. DMEK offers excellent visual rehabilitation for corneal decompensation associated with ICE, with reported postoperative visual acuity typically ranging from 20/20 to 20/40 and endothelial cell densities of 1,000–1,600 cells/mm². However, DMEK in phakic patients poses unique intraoperative challenges, including reduced anterior chamber depth and increased risk of lens touch or cataract formation. Surgical modifications—such as controlled gas fills, gentle graft manipulation, and vigilant postoperative monitoring—are essential to prevent complications such as pupillary block or graft detachment. DMEK provides favorable outcomes in Chandler syndrome but requires careful patient selection and surgical adaptation in phakic eyes. Surgeons should counsel younger patients about the potential need for future cataract surgery and tailor techniques to balance visual restoration with long-term ocular integrity.

    Presentation Date: 11/06/2025
    Issue Date: 03/13/2026