Late-onset bullous keratopathy after iris-fixated phakic intraocular lens implantation: a case report

This article presents a case report of bullous keratopathy occurring 12 years after implantation of iris-fixated anterior chamber phakic intraocular lenses (AC pIOL), which eventually required Descemet Membrane Endothelial Keratoplasty (DMEK). This represents a much longer period of endothelial decompensation following implantation than that reported in other studies.

A 44-year-old woman presented with pain and reduced vision which was diagnosed as uveitis; it was unresponsive to topical steroids. Twelve years earlier, she had iris-fixated AC pIOLs (Myopia Artiflex 6 mm) implanted in both eyes for correction of myopia. Substantial endothelial loss with a bullous keratopathy was identified and both intraocular lenses were explanted. Owing to endothelial decompensation in the left eye, the patient required a left Descemet Membrane Endothelial Keratoplasty.

As the same models of AC pIOLs are still in use today, clinicians should be aware of this serious complication when considering different refractive error correction procedures. Our report highlights that endothelial decompensation as a complication of AC pIOL implantation can occur many years after lens implantation, and emphasizes the need for long-term endothelial monitoring.