Long-term endothelial cell loss in patients with artisan myopia and artisan toric phakic intraocular lenses 5- and 10-year results

S.M.R. Jonker, T.T.J.M. Berendschot, A.E. Ronden, I.E.Y. Saelens, N.J.C. Bauer, R.M.M.A. Nuijts

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Purpose: To evaluate the long-term change in endothelial cell density (ECD) after the implantation of 2 types of rigid iris-fixated phakic intraocular lenses (pIOLs) for the treatment of myopia and astigmatism. Design: Prospective, clinical cohort study. Participants: A total of 507 eyes of 289 patients receiving the Artisan Myopia or Artisan Toric (Ophtec B.V., Groningen, The Netherlands) iris-fixated pIOL for the treatment of myopia or astigmatism at the University Eye Clinic Maastricht as of January 1998. Methods: A total of 381 myopic and 126 toric pIOLs were implanted. Five- and 10-year follow-ups were completed by 193 and 127 eyes implanted with the myopic pIOL and by 40 and 20 eyes implanted with the toric pIOL, respectively. Main Outcome Measures: Chronic endothelial cell (EC) loss, percentage of eyes with a decrease of ≥25% in ECD, and percentage of eyes with an ECD <1500 cells/mm 2. Results: Chronic EC loss was calculated from 6 months postoperatively to the end of follow-up and showed an annual ECD decline of 48 cells/mm 2 (standard error, 3.14) and 61 cells/mm 2 (standard error, 6.30) in the myopic (P < 0.001) and toric (P < 0.001) groups, respectively, resulting in a total EC loss of 16.6% and 21.5% from 6 months to 10 years postoperatively, respectively. Ten years after implantation, ECD had decreased by ≥25% in 7.9% and 6.3%, whereas ECD was <1500 cells/mm 2 in 3.9% and 4.0% in the myopic and toric groups, respectively. Explantation of the pIOL occurred in 6.0% in the myopic group and 4.8% in the toric group. Risk factors for increased EC loss were a shallow anterior chamber depth (ACD) (P ≤ 0.005) and a smaller distance between the central and peripheral pIOL edge to the endothelium (P ≤ 0.005). Conclusions: A significant linear chronic EC loss was reported after implantation with myopic or toric iris-fixated pIOLs. A smaller ACD and smaller distance between pIOL edge and endothelium were risk factors for EC loss. Modification of preoperative age-related ECD thresholds is indicated to maintain an ECD that warrants safe future combined pIOL explantation and cataract surgery.

Original languageEnglish
Pages (from-to)486-494
Number of pages9
Issue number4
Publication statusPublished - Apr 2018


  • Adolescent
  • Adult
  • Aged
  • Anterior Eye Segment/diagnostic imaging
  • Astigmatism/surgery
  • Child
  • Child, Preschool
  • Chronic Disease
  • Cohort Studies
  • Corneal Endothelial Cell Loss/diagnosis
  • Female
  • Follow-Up Studies
  • Humans
  • Iris/surgery
  • Lens Implantation, Intraocular/adverse effects
  • Male
  • Middle Aged
  • Myopia/surgery
  • Ophthalmoscopy
  • Phakic Intraocular Lenses
  • Prospective Studies
  • Refraction, Ocular/physiology
  • Risk Factors
  • Tomography, Optical Coherence
  • Tonometry, Ocular
  • Visual Acuity/physiology


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