Reply : Long-term efficacy and safety profiles of iris-fixated foldable anterior chamber phakic intraocular lens implantation in eyes with more than 10-years of follow-up.

Abstract

We thank Tello et al. for their interest in our study, for their valuable comments, and for sharing their long-term experience regarding endothelial cell (EC) loss after phakic intraocular lens (IOL) implantation. In our series, the percentage of eyes that lost more than 1.6% of EC density yearly (upper limit of normality obtained from the study by Bourne et al.) was 19.7% (15/76).1 However, of those 15 eyes, 11 had an endothelial cell count (ECC) of more than 2000 cells/mm2 and none have lost more than 25% of their EC density at the final follow-up. Four eyes of 3 patients (5.2%) had less than 2000 cells/mm2 and have lost more than 25% of their ECC at the final follow-up, and this is similar to the 5-year results reported by Jonker et al. in their Artiflex study (4.3% - 4.4%).2 The mean age of these patients was 49 years. Two of those 4 eyes (1 patient) underwent combined phakic IOL explantation plus cataract surgery 9.3 years after the initial surgery, as described in the “Adverse Events” section of the “Results”. The remaining 2 eyes (2 patients) had more than 1900 cells/mm2 at the last follow-up, the phakic IOL was not explanted because both eyes had excellent visual acuity, their ECC was still considered safe, explanting the phakic IOL would result in a high anisometropia, and because at the last follow-up, they were not candidates for crystalline lens surgery; however, both patients are being closely followed. We think that the potential risks of these implantations should be borne in mind, especially the long-term loss of EC. Patients must be checked regularly and instructed to avoid rubbing their eyes to diminish the risk of accelerated EC loss and therefore early explantation; in fact, at our center, these are two of the main issues that are discussed preoperatively with the patients.