Complications of anterior chamber lens implants and their effects on the endothelium

A five-year follow-up study of 186 eyes which were subject to intracapsular cataract extraction and rigid anterior chamber lens implantation is reported. Ninety-two per cent of cases achieved a visual acuity of 6/12 or better. Serial corneal endothelial cell counts were performed. In 37 pairs of eyes the median difference in operative endothelial cell loss between the operated and un-operated eyes was -7.3% (95% Confidence Interval from -8.7 to -6.1%). Iris tuck occurred in 22.0% and late 'iris ovalling' developed in a further 15.6% of eyes. The median operative endothelial cell loss for those eyes with iris tuck was -9.7% and this was significantly higher than that of eyes with no long-term complications (median loss = -7.3%). The median operative endothelial cell loss for those eyes which developed late ovalling was -8.0% and this was not significantly greater than that of the eyes with no long-term complications (p = 0.745). There was a progressive median endothelial cell loss for all operated eyes and this progressive cell loss was significantly greater for those eyes with iris tuck when compared with those with no complications (p = 0.045).