Endothelial study of iris-claw phakic lens: Four year follow-up

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Abstract
Purpose: To study quantitative and morphometric endothelial changes in phakic eyes implanted with the Worst iris-claw lens to correct high myopia. Setting: Department of Ophthalmology, University Hospital “La Fe”, Valencia, Spain. Material and Methods: This retrospective study involved 111 phakic eyes (73 patients) implanted with the Worst iris-claw lens. Noncontact specular microscopy and computer-assisted analysis was performed preoperatively and 6 months and 1, 2, 3, and 4 years postoperatively. Results: The mean cell loss was 3.85% at 6 months, 6.59% at 1 year, 9.22% at 2 years, 11.68% at 3 years, and 13.42% at 4 years. At 2 years, the hexagonality and coefficient variation in cell size were close to the preoperative levels. No major complications were seen; early postoperative corneal touch required intraocular lens (IOL) removal in 1 case (0.9%). Four eyes (3.6%) needed a reoperation because of poor IOL fixation (2 eyes), traumatic subluxation of the IOL (1 eye), and miscalculation of the IOL power (1 eye). Conclusions: Although there was a slight, progressive cell loss after IOL implantation, the morphometric changes recovered and were close to the preoperative levels. This suggests that endothelial damage occurred primarily during the surgical procedure.