Abstract
Purpose To investigate the long-term changes of corneal endothelial cells (EC) in anterior chamber intraocular lens- (AC-IOL-) implanted eyes. Methods Retrospective study. We included 37 eyes (25 patients) that received AC-IOL implantation previously in the Eye and ENT Hospital of Fudan University between 1995 and 2016. Follow-up outcomes included the best-corrected visual acuity (BCVA), endothelial cell density, hexagonality, coefficient of variance, and central corneal thickness. Results In total, 23 eyes (62.16%) with phakic and 14 eyes (37.84%) with aphakic AC-IOLs were included. Among these, 3 eyes (8.11%) were angle-supported AC-IOLs and 34 eyes (91.89%) were Artisan iris-fixated AC-IOLs. The mean age of patients was 41.40 ± 17.17 years, and the mean follow-up time was 12.12 ± 4.71 years in our study. At the follow-up time, corneal decompensation existed in 3 angle-supported AC-IOL eyes with a rate of 100% and 15 iris-fixated AC-IOL eyes with a rate of 44.12%. AC-IOL displacement occurred in 14 (41.18%) iris-fixated AC-IOL eyes. In the 19 iris-fixated AC-IOL eyes without corneal decompensation, significant changes also took place in corneal endothelial cells. The endothelial cell density decreased from 2843.26 ± 300.76 to 2015.58 ± 567.99 cells/mm2 (29.1% loss, P < 0.001) and hexagonality decreased from 51.21 ± 7.83 to 42.53 ± 9.17 (%) (16.9% loss, P < 0.001). The Kaplan–Meier survival curve also demonstrated the accumulated expectation rates of corneal endothelial cell decomposition for AC-IOLs with a median survival time of 12 years. Conclusion We reported a significant chronic loss and long-term decompensation destiny of corneal endothelial cells in AC-IOL eyes. Semiannual or annual follow-up and evaluation of endothelial cells should be conducted in AC-IOL-implanted patients.
Highlights
Anterior chamber intraocular lenses (AC-IOLs) have been widely used in the past two decades in phakic myopic eyes and in aphakic eyes after a cataract extraction procedure
E endothelial cell density is a key criterion for accessing the safety of AC-IOLs. e importance of endothelial cell density (ECD) loss for measuring the safety of the anterior chamber was emphasized by the American Academy of Ophthalmology (AAO) in early 2017 [7]. e AAO Task Force guidelines recommend that the percentage of eyes with a total ECD loss ≥25% after 3 years be used as an endpoint of investigation criterion
For chronic endothelial cell changes in the 19 iris-fixated AC-IOL eyes without corneal decompensation, we found a significant decrease of ECD and hexagonality (Figure 2(a) and 2(b)). e endothelial cell density decreased from 2843.26 ± 300.76 to 2015.58 ± 567.99 cells/mm2 (29.1% loss, P < 0.001) and hexagonality decreased from 51.21 ± 7.83
Summary
Anterior chamber intraocular lenses (AC-IOLs) have been widely used in the past two decades in phakic myopic eyes and in aphakic eyes after a cataract extraction procedure. Ough their effectiveness in correcting refractive errors has been soundly proven [1,2,3], their long-term safety and reliability are still an unresolved question, as most follow-up data of eyes implanted with anglesupported and iris-fixated IOLs were for less than five years [4,5,6]. E endothelial cell density is a key criterion for accessing the safety of AC-IOLs. e importance of endothelial cell density (ECD) loss for measuring the safety of the anterior chamber was emphasized by the American Academy of Ophthalmology (AAO) in early 2017 [7]. Our study aimed to provide some predictive data to foresee the long-term trend of corneal endothelial cells in ACIOL-implanted eyes
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