A 51-year-old woman developed a symptomatic secondary iris cyst after an aberrant suture removal following a penetrating keratoplasty (PK) for keratoconus. The 5.6×2.7-mm implantation iris cyst filled the superior anterior chamber, abutting the corneal endothelium. The cyst was initially treated with aspiration and lavage with absolute alcohol and 5-fluorouracil (5-FU). However, 7 months after, the cyst recurred and definitive surgical treatment was required. She underwent iris cyst excision and pupilloplasty combined with phacoemulsification and placement of an IOL with two Morcher 96F segments in the capsular bag. Failure of the corneal endothelium shortly followed, as expected, and a Descemet-stripping automated endothelial keratoplasty under her existing PK was performed. In this video, we present the surgical videos detailing the management of this large cyst and subsequent lamellar keratoplasty.