New Perspectives In The Prediction Of Endothelial Cell Loss After Artiflex Implantation

Phakic intraocular lens implantation has the risk of increasing corneal endothelial cell loss beyond physiologic levels. In regard to Artiflex lens,  multiple parameters have been studied. Here we present a new way of evaluating the relationship between the lens and the rate of cell loss, calculating the anterion chamber (AC) area between the artiflex lens and the corneal endothelium.

The study was performed in Centro Hospitalar e Universitário de São João, Porto.

The patients selected began their following after 2018.

We selected 31 eyes from patients submitted to Artiflex implantation, while gathering pre-operative and post-operative endothelial cell count estimation results by specular microscopy. The interval of analysis varied between 1 and 7 years after surgery. We also analyzed post-operative anterior-segment ocular coherence tomography and measured the distance between endothelium and the intraocular lens in optic axis and to the nasal and to the temporal haptics. By connecting these points in the endothelium and in the artiflex a double quadrilateral area above artiflex is formed which can be calculated by dividing each into two triangles.

Of all variables studied, the variation in endothelial cell count was the only that didn´t follow normal distribution (Shapiro-wilk: p=0.000).

The average annual decrease in endothelial cell count was 1.76% ±1.41.

Spearman correlation results show a statistically significant negative correlation between variation in endothelial cell count and the endothelium-lens distance aligned in the optic axis (-0.649; p=0.000); the distance to the nasal haptic (-0.548; p=0.001) and to the temporal haptic (-0.449). There was no statistically significant correlation with distance between artiflex and lens.

The area above Artiflex also presents a statistically significant negative correlation with variation in endothelial cell count (-0.573, p=0.001).

This is the only study to our knowledge that describes the relationship between the decrease in endothelial cell count and the area above artiflex lens.

Our proposition is that endothelium-lens distance aligned in the optic axis and to the haptics isn´t the only important aspect of the spatial location of the lens.

Further studies are needed to elaborate on the proposed hypothesis and on aspects of optimizing the area described.