Severe endothelial cell loss following uneventful angle-supported phakic intraocular lens implantation for high myopia

Abstract

Endothelial decompensation is a serious complication of phakic intraocular lens (pIOL) implantation and is a major concern during the postoperative period. We report 3 eyes in which the same foldable angle-supported pIOL was implanted to correct high myopia. Rapid and severe postoperative endothelial cell loss occurred in all 3 eyes. An over-sized pIOL that induced excessive vaulting into the anterior chamber was the main risk factor. In 2 eyes, the pIOL was explanted uneventfully; 1 eye required Descemet's stripping automated endothelial keratoplasty because of total endothelial decompensation. These cases illustrate the importance of accurate sizing of foldable angle-supported anterior chamber pIOLs to avoid excessive vaulting. They also highlight the importance of regular follow-up and preventive pIOL explantation as soon as significant endothelial cell loss is detected.

Phakic Intraocular Lens Implantation: Refractive Outcome and Safety in Patients with Anterior Chamber Depth between 2.8 and 3.0 versus ≥3.0 mm

“…In our center, there were no cases of endothelial decompensation or need for IOL explantation. However, a few cases of severe ECL that led to pIOL explantation and even Descemet's stripping automated endothelial keratoplasty have been reported with this particular pIOL, mainly because of IOL rotation, eye rubbing, or an oversized pIOL that induced excessive vaulting [21,22] . Therefore, appropriate patient selection, acceptable ACD, preoperative EC density and ciliary sulcus diameter measurement, as well as close patient surveillance are needed to prevent severe complications.…”

Quadruple Procedure for Visual Rehabilitation of Endothelial Decompensation Following Phakic Intraocular Lens Implantation

“…[1][2][3][4][5][6] Endothelial failure has been reported as early as 2 years and as late as 14 years after surgery. [3][4][5] Proposed mechanisms for this complication include trauma during implantation and/or postoperative intermittent contact between phakic IOL and endothelium because of poor phakic IOL fixation, improper phakic IOL sizing, and/or eye rubbing.…”

“…[1][2][3][4][5][6] Endothelial failure has been reported as early as 2 years and as late as 14 years after surgery. [3][4][5] Proposed mechanisms for this complication include trauma during implantation and/or postoperative intermittent contact between phakic IOL and endothelium because of poor phakic IOL fixation, improper phakic IOL sizing, and/or eye rubbing. 1,4,6 Accelerated endothelial cell loss following phakic IOL implantation can be treated with phakic IOL explantation or bilensectomy (ie, removal of phakic IOL and of the crystalline lens), but the simultaneous presence of frank endothelial decompensation also requires replacement of the dysfunctional corneal endothelium.…”

“…[3][4][5] Proposed mechanisms for this complication include trauma during implantation and/or postoperative intermittent contact between phakic IOL and endothelium because of poor phakic IOL fixation, improper phakic IOL sizing, and/or eye rubbing. 1,4,6 Accelerated endothelial cell loss following phakic IOL implantation can be treated with phakic IOL explantation or bilensectomy (ie, removal of phakic IOL and of the crystalline lens), but the simultaneous presence of frank endothelial decompensation also requires replacement of the dysfunctional corneal endothelium. In addition, endothelial keratoplasty alone in the presence of a phakic IOL may be difficult to perform, and both donor endothelium and the patient's crystalline lens could be damaged during graft delivery and placement, as well as during air filling at the end of the procedure.…”

Corneal endothelial decompensation after iris-claw phakic intraocular lens implantation

“…1 However, recent long-term studies report significant reductions in endothelial cell density after 3 years, 2,3 and recent case reports show severe endothelial cell loss after uneventful pIOL implantation for high myopia. 4,5 We describe a patient who developed corneal endothelial decompensation after Artisan pIOL implantation in both eyes.…”