A 27-year-old woman had foggy vision and photophobia since 10 months after implantation of implantable collamer lens (ICL STAAR Surgical AG, Nidau, Switzerland) with evidence of corneal decompensation and no cataract formation. Descemet membrane endothelial keratoplasty in phakic eyes is challenging, considering presence of posterior chamber phakic intraocular lens (IOL), decreasing the space available in anterior chamber to manoeuvre the graft. Need of inferior peripheral iridotomy in presence of central hole technology in ICL depends on the dynamics of full chamber air bubble. At 8 months, vision had improved to 20/20 and normal IOP with well-attached graft, stable phakic IOL and clear lens.