Long-term endothelial changes in phakic eyes after Artisan intraocular lens implantation to correct myopia

Abstract

PURPOSE: To evaluate long-term endothelial cell changes in eyes that had implantation of an iris-fixated phakic Artisan intraocular lens (IOL) for moderate to high myopia. SETTING: Casa di Cura Villa Igea, Ancona, Italy. METHODS: Forty-nine eyes of 30 patients having implantation of Artisan IOL for moderate to high myopia were prospectively examined. Preoperative specular microscopy and serial postoperative specular microscopy (Noncon Robo SP 8000, Konan Medical) were performed to evaluate endothelial cell changes over 5 years. Endothelial cell images were collected in the central region of the cornea before surgery and 4, 12, 24, 36, 48, and 60 months after surgery. The endothelial cell density (ECD), coefficient of variation, and percentage of hexagonal cells were determined. RESULTS: Preoperatively, the mean ECD was 2616 cells/mm² ± 347 (SD), the mean coefficient of variation was 39.6% ± 4.7%, and the mean percentage of hexagonal cells was 49.2% ± 6.7%. The mean endothelial cell loss from preoperatively was 2.3% at 4 months, 3.5% at 12 months, 4.7% at 24 months, 6.7% at 3 years, 8.3% at 4 years, and 9.0% at 5 years. Five years after surgery, the mean coefficient of variation was 35.9% ± 6.9% (P = .1946) and the percentage of hexagonal cells was significantly higher (mean 54.7% ± 10.3%) (P = .087). CONCLUSIONS: Continuous endothelial cell loss was observed after surgery during a 5-year follow-up, especially during the first 2 years. A decrease in the coefficient of variation and an increase in the percentage of hexagonal cells were observed over time, reflecting the increasing stability and remodeling of the corneal endothelial cells 5 years postoperatively.