Localized Corneal Decompensation from Positional Endothelial Touch of Iris-claw Phakic Intraocular Lens

We report a case of localized corneal decompensation due to positional endothelial touch from a phakic iris-claw intraocular lens (IOL). A 38-year-old highly myopic woman underwent phakic iris-claw IOL implantation with subsequent re-enclavation. Seventeen years later, she presented with blurred vision and nasal corneal edema. The IOL was noted to be eccentrically enclaved with localized edema corresponding to the nasal claw. Imaging confirmed the absence of lens-cornea touch in the sitting position, suggesting intermittent endothelial trauma. This case highlights the importance of long-term follow-up in phakic IOL patients to detect delayed complications from subtle malposition.