Endothelial Cell Loss in Anterior Chamber Phakic Intraocular Lenses: The Role of Critical Distance at Different Meridians
DOI:
https://doi.org/10.48560/rspo.32893Keywords:
Anterior Chamber, Corneal Endothelial Cell Loss, Endothelium, Corneal, Myopia/surgery, Phakic Intraocular LensesAbstract
INTRODUCTION: Our aim was to assesses the influence of minimum distance from the edge of the anterior chamber phakic intraocular lens (iris-fixated pIOL) to the corneal endothelium (critical distance; CD) measured at four different points using high-resolution sweptsource optical coherence tomography (ANTERION® Heidelberg Engineering) on endothelial cells density (ECD).METHODS: A cross-sectional study was performed on patients who underwent Artiflex® implantation between 2003 and 2022. Eyes submitted to iris-fixated pIOL explantation or lost to follow-up were excluded. All eyes underwent CD evaluation with ANTERION® in 2023 at four evaluation points: nasal (N), superior (S), temporal (T) and inferior (I). ECD and anterior chamber depth were also evaluated. A mixed-effects linear regression was performed to assess the effect of CD on annual ECD loss, adjusting for age. Receiver operating characteristic (ROC) curves were used to assess the discriminative ability of CD at each location.
RESULTS: Sixty-three patients (108 eyes) were included in this study. The mean±SD age was 31.3±5.4 years. The median (IQR) follow-up was 12.67 (11.75 – 15.38) years. The mean±SD CD at N, T, S and I points were 1.47±0.24, 1.54±0.24, 1.64±0.27 mm and 1.49±0.34, with significant differences between locations (N vs S points and S vs I, both p<0.001). The mean±SD minimum CD at any point was 1.33±0.25 mm. The mixed-effect linear analysis revealed a significant effect of CD at all locations on annual ECD percentual loss with N location presenting the highest coefficient. Using a mean distance of 1.5 mm in the linear model, an annual ECD loss of 1.38%, 1.38%, 1.50% and 1.52% was predicted for N, T, S and I points, respectively. Using annual ECD loss of 1% as cut-off, the S distance presented the highest AUROC.
CONCLUSION: The evaluation of critical distances at the 4 different points seems to be relevant in the follow-up of patients with iris-fixated pIOL. In addition to ECD, the annual follow-up visits of patients with iris-fixated pIOL should include the measurement of critical distance by points and not only on the horizontal meridian.
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