Long-term endothelial cell loss with the iris-claw intraocular phakic lenses (Artisan®)

• Published in: Graefe's archive for clinical and experimental ophthalmology 2019-12, Vol.257 (12), p.2775-2787
• Main Authors: Galvis, Virgilio, Villamil, John F., Acuña, María Fernanda, Camacho, Paul A., Merayo-Lloves, Jesús, Tello, Alejandro, Zambrano, Sandra Lizeth, Rey, Juan José, Espinoza, Juan Vicente, Prada, Angélica María
• Format: Article
• Language: English
• Subjects: Cataracts; Cell density; Edema; Endothelial cells; Iris; Medical records; Medicine; Medicine & Public Health; Ophthalmology; Refractive Surgery; Statistical analysis
• ISSN: 0721-832X; 1435-702X
• DOI: 10.1007/s00417-019-04506-9

Purpose To evaluate the endothelial cell loss in patients with iris-claw phakic lenses (Artisan®) in a long-term follow-up. Methods We analyzed the medical records of patients who had undergone iris-claw phakic lens implantation and who had at least 5 years of follow-up. Results We included 67 eyes with myopic errors (follow-up 9.6 ± 3.0 years) and 10 eyes with mixed astigmatism or hyperopic errors (follow-up 8.8 ± 2.5 years). The mean total endothelial density loss at the last follow-up visit was 18.5% ± 17.0% and 10.5% ± 12.3%, respectively. 29.9% of the eyes in the myopic group and 20% in the hyperopic group lost more than 25% of the preoperative endothelial cell density. During the postoperative follow-up period, 60.8% of the eyes in the myopic group and 40% of the eyes in the hyperopic group lost a higher percentage than the expected physiological loss. Two eyes in the myopic group (3.0%) had a final cell density of less than 1200 cells/mm 2 . None of the variables studied had a statistically significant association with the percentage of annual endothelial loss in the postoperative period. Three phakic lenses were explanted: two by cataract and one by cataract and severe decrease of the endothelial density (862 cells/mm 2 ). Conclusions There is a significant endothelial cell loss in a low percentage of the eyes with Artisan® lenses in the long term, and it can decrease to critical levels. Periodic endothelial density evaluations are required for these patients. The selection criteria of surgical candidates could be reevaluated.