Progressive Endothelial Cell Loss Secondary To Phakic Anterior Chamber Intraocular Lenses

Abstract

Abstract: : Purpose: To present a natural history case of a patient with bilateral phakic angle supported anterior chamber intraocular lenses (ACIOLs) who demonstrated progressive endothelial cell loss and increased corneal thickening over 5 years. Methods: A 37 yo woman underwent implantation of bilateral angle-supported phakic ACIOLs 5 years prior. Her preoperative refractive error was +4.25 OU with endothelial cell counts (ECC) of 2328mm₂ OD and 2347mm₂ OS, and central pachymetry (CP) of 0.522mm OD and 0.535mm OS. She also had accommodative esotropia corrected fully by the implants. Results: Serial ECCs were measured over the ensuing 5 years and had displayed deterioration to 700mm₂ OU. The CP had increased to 0.590mm OD and 0.595mm OS. The visual acuity(VA) was 20/20 OD and 20/25+ OS without correction. She underwent explantation of the lenses. There was incarceration of one haptic into the peripheral iris in OS making removal very difficult. The ECC have continued to deteriorate and there is moderate polymegathism and pleomorphism although the best corrected VA is 20/20 OU. Conclusion: Angle supported phakic ACIOLs may cause progressive endothelial cell loss in hyperopic patients. It is not clear whether improvement of the design of phakic ACIOL technology will provide a safer modality and preserve the corneal endothelium long-term.

Keywords: 551 refractive surgery: phakic IOL