Cornea Endothelial Cell Loss Before and After Explantation of Artisan and Artiflex Iris-Fixated Phakic Intraocular Lenses

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2024-10-18 DOI:10.1016/j.ajo.2024.10.010

Hye yeon Yoon MD. , Yong-Soo Byun MD., PhD. , Hyun Seung Kim MD., PhD. , So-Hyang Chung MD., PhD.

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引用次数: 0

Abstract

PURPOSE

To investigate the risk factors for corneal endothelial cell density (ECD) loss of 2 types of iris-fixated phakic intraocular lenses (pIOL) and indicate the cutoff values for preventing irreversible ECD loss after explantation.

DESIGN

The retrospective, comparative, clinical cohort study.

METHODS

Total 114 eyes of 61 patients were included in this study. Fifty-five eyes with Artisan pIOL and 59 eyes with Artiflex pIOL had undergone explantation of pIOLs due to continuous ECD loss. Correlation analysis was performed to assess the ocular parameters associated with ECD loss. Receiver operating characteristic (ROC) curve was performed to set cutoff values of ocular parameters to prevent ECD loss after explantation.

RESULTS

The mean ECD before explantation was 1637 cells/mm² in Artisan group and 1769 cells/mm² in Artiflex group. The distance of cornea endothelium to IOL center and edges were all significantly higher in Artisan group (P < .05). The risk factor of decreased ECD in Artisan group were small anterior chamber angle (ACA), and distance of nasal edge of IOL to endothelium and iris fixation to nasal limbus distance, and differences of fixation length. In Artiflex group, ACA, distance of nasal edge of IOL to endothelium, both limbus to IOL fixation length, fixation length, iris pigmentation grading were the risk factors. At 1 year after the pIOL removal, the population demonstrating ΔECD >10% were significantly higher in Artisan group than Artiflex group (P < .05). In ROC curve analysis, the cutoff value of preoperative ECD to prevent significant postexplantation ECD loss was 1683.5 cells/mm² in Artisan group and 1648 cells/mm² in Artiflex group.

CONCLUSIONS

This study examined the existing explantation guidelines for these lenses. In analyzing the longterm prognosis of cornea ECD with Iris-fixated phakic intraocular lens, it is important to identify the relevant anatomical factors. Small ACA, and short distances from IOL to endothelium and from limbus to iris fixation especially in the nasal region were significant risk factors to continuous ECD loss in both lenses. To minimize irreversible ECD loss after explantation, it is important to determine the optimal period of explantation by observing both ECD and structural changes.

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Artisan 和 Artiflex 虹膜固定法康眼内透镜取出前后的角膜内皮细胞损失。

目的：研究两种虹膜固定型人工晶体（pIOL）角膜内皮细胞密度（ECD）损失的风险因素，并指出防止角膜内皮细胞密度在角膜摘除术后不可逆转损失的临界值。其中 55 隻使用 Artisan pIOL 的眼睛和 59 隻使用 Artiflex pIOL 的眼睛因持續 ECD 損失而接受了 pIOL 剝離手術。研究人员进行了相关性分析，以评估与 ECD 损失相关的眼部参数。结果Artisan组和Artiflex组患者摘除前的平均ECD分别为1637个细胞/平方毫米和1769个细胞/平方毫米。Artisan组角膜内皮到人工晶体中心和边缘的距离均显著高于Artiflex组（P＜0.05）。在 ROC 曲线分析中，Artisan 组术前 ECD 的临界值为 1683.5 个细胞/mm2，Artiflex 组为 1648 个细胞/mm2，从而避免了植入后 ECD 的明显损失。在分析使用虹膜固定法晶体的角膜 ECD 的长期预后时，确定相关的解剖因素非常重要。小 ACA、从 IOL 到内皮和从角膜缘到虹膜固定的短距离，尤其是在 nasaSSSl 区域，是导致两种镜片 ECD 持续丧失的重要风险因素。为了最大限度地减少角膜屈光度丧失，必须通过观察角膜屈光度和结构变化来确定最佳的角膜屈光度丧失时间。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.