Ang M, et al. - In the present study, the researchers sought to describe a surgical approach involving anterior segment reconstruction with CustomFlex Artificial Iris (CAI; HumanOptics, Erlangen, Germany) followed by Descemet membrane endothelial keratoplasty (DMEK) in complex eyes with corneal decompensation. Five eyes of five patients (median age 61 years, range 27–69 years; 60% female) had anterior segment reconstruction with CAI implantation (4 suture-fixated), followed by successful DMEK surgery (median 2 months later, range 1–5 months). This pilot study illustrates a feasible method of initial anterior segment reconstruction with CAI implantation, prior to DMEK, in eyes with significant anterior segment abnormalities like iris damage or extensive peripheral anterior synechiae and corneal decompensation.