Corneal Endothelial Changes after Iris-Claw Anterior Chamber Phakic Intraocular Lens Implantation

Abstract

Background: Compared to other refractive surgeries, implantation of phakic intraocular lenses (pIOL) have more desirable results and are potentially reversible procedures due to the possibility of explanting these lenses. These methods usually do not require expensive or special surgical equipment and most ophthalmologists are able to perform these procedures., however disabilities resulting from pIOL are more severe compared to corneal refractive surgery. Due to the potential risk of damage to anterior segment structures, especially corneal endothelial cell loss, pIOL implantation is subjected to debate. Aim of the Work: To evaluate the endothelial cell count changes in eyes implanted with the iris-claw phakic lens for treatment of moderate to high myopia as regard changes in cell density. Patients and Methods: This study included Ten eyes of patients with moderate to high myopia implanted with The Iris-Claw Anterior Chamber Phakic Intraocular Lens at Al-Hussein University Hospital, In this prospective randomized study we did Preoperative specular microscopy and serial postoperative specular microscopy (Topcon SP- 1P, Topcon Medical Inc., Japan).) were performed to evaluate endothelial cell count changes over 6 months. Endothelial cell images were collected in the central region of the cornea before surgery and 1 and 6 months after surgery. The main outcome measures were central corneal ECD and the percentage of corneal endothelial cell loss. Secondary outcome measures were UCVA, BCVA, manifest refraction, and complications. Results: Preoperative mean endothelial cell count was 3198.50 ± 444.67 cells/ mm² (range, 2715.00 – 3846.00 cells/ mm²)., it was 3074.50 ± 410.76 cells/ mm² (range, 2609.00 – 3686.00 cells/ mm²) at 1 month after surgery., 3003.00 ± 411.91cells/ mm² (range, 2532.00 – 3610.00cells/ mm²) at 6 months after surgery. The mean endothelial cell loss was 6.07% at the end of the follow up period with 3.79% at one month postoperative, 2.37% from one to six months postoperative. The mean BCVA improved from 0.27 ± 0.09 preoperatively to 0.44 ± 0.12 postoperatively and the mean UCVA, from 0.02 ± 0.01 to 0.33 ± 0.09 postoperatively, the mean SE was -0.93 ±0.57 D Postoperatively. Conclusion: Artisan phakic IOL had excellent results including., their suitability for high myopes, reversibility, high optical quality, predictability, safety, efficacy, potential gain in visual acuity in myopic patients and did not produce significant corneal endothelial cell loss 6months after surgery.