Special Report: American Academy of Ophthalmology Task Force Recommendations for Specular Microscopy for Phakic Intraocular Lenses

Long-Term Endothelial Cell Loss in Patients with Artisan Myopia and Artisan Toric Phakic Intraocular Lenses

“…In both the distant and recent past, a multitude of anterior chamber angle-supported and iris-fixated pIOLs have been taken off the market because of excessive EC loss and complications such as pupil ovalization and cataract formation. 1,2,11,12 Subsequently, researchers and authorities have been pressed to formulate guidelines specifying safety criteria for implantation of anteriorchamber pIOLs. 1,2,11,17,28e30 In the current study, we applied recently formulated criteria by the AAO Task Force and the AFSSAPS on EC analysis after pIOL implantation to a cohort of myopic and toric pIOL patients with a follow-up of 10 years.…”

“…1,2,11,17,28e30 In the current study, we applied recently formulated criteria by the AAO Task Force and the AFSSAPS on EC analysis after pIOL implantation to a cohort of myopic and toric pIOL patients with a follow-up of 10 years. 11,12 We believe that our patient cohort is unique in that over the entire 10-year follow-up period the same protocol and the same specular microscope were used, thereby decreasing the variability in data acquisition and increasing the reliability of our ECD data. 23e26…”

“…The definitions of outcome measures were based on the recent guidelines of the AAO and AFSSAPS, describing the percentage of eyes reaching the AAO end point (i.e., EC loss !25% compared with the preoperative measurement) and AFSSAPS explantation criterion (i.e., ECD <1500 cells/mm 2 ). 11,12 We calculated the mean ECD 5 and 10 years after pIOL implantation, as well as the annual EC loss. To adhere to the AAO-defined guidelines, we not only presented the percentage of eyes meeting the AAO-defined end point after 5 and 10 years but also added the percentage of eyes meeting this end point after 3 years.…”

“…To adhere to the AAO-defined guidelines, we not only presented the percentage of eyes meeting the AAO-defined end point after 5 and 10 years but also added the percentage of eyes meeting this end point after 3 years. 12…”

“…In addition, the AFSSAPS guidelines describe an ECD of less than 1500 cells/mm 2 as an explantation criterion. 11,12 However, so far none of the published studies have used these newly established EC loss criteria as outcome measures. In this study, we applied these criteria as outcomes measures in our patient cohort of myopic and toric pIOLs that was followed over a 10-year period using the same specular microscope and ECD measurement protocols.…”