This patient had bilateral phakic IOLs implanted about a year ago to address a high degree of myopia. Now the left eye is stable with a well-centered and positioned phakic IOL and the endothelial cell count in that eye is stable. However the right eye has displacement of the phakic IOL and significant corneal endothelial cell loss, from 2400 cells/mm2 to 1600 cells/mm2 now. What should you do? Remove the phakic IOL and then replace it with another? Remove the phakic IOL from this eye and have the patient go back to wearing a contact lens? Or remove the phakic IOL and make the patient pseudophakic? Tough decisions for a young patient.