الفهرس 
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Abstract
Myopia and uncorrected errors of refraction are amongst the most common ophthalmic problems. There are different lines of treatment of myopia. Conservative management includes spectacles and contact lenses. Surgical options includes corneal refractive surgery, refractive lens exchange, and phakic intraocular lens implantation in the anterior or the posterior chamber. Patients with high error and/or thin corneas are not suitable for laser refractive surgery. Refractive lens exchange results in loss of accommodation and increased risk of retinal detachment.
In this study we evaluated the outcomes of implantation of Artisan phakic IOL for treatment of high myopia regarding primarly the change of corneal endothelial cell density. We also evaluated the visual and refractive outcomes of the procedure.
The study was a prospective non comparative case series. It included 12 eyes of 7 patients with myopia ranged between -6.75 and -21.25 diopters. Artisan phakic IOL was implanted in the period between June 2018 and October 2019. With a follow-up period of 6 months after surgery.
The mean endothelial cell count decrease from 2748.33±73.594 cells/ mm² preoperatively to 2736.75±82.275 cells/ mm² at 1 month after surgery and to 2567.50±104.458 cells/ mm² at 6 months after surgery.
The mean endothelial cell loss was 6.19% at the end of the follow up period with 2.72% at one month postoperative, 3.62% from one to six months postoperatively.
At the end of the follow up period, no case showed endothelial cell count less than 2000 cells/ mm².
Regarding visual acuity, postoperative UCVA had statistically very highly significant improvement from preoperative value. Preoperatively, no eye had UCVA for more than 4/60(0.07) while at six months postoperatively, 2 eyes had UCVA of 6/18(0.33) , 3 eyes had UCVA of 6/12(0.5) , 2 eyes had UCVA of 6/9(0.67), 5 eyes had UCVA of 6/6(1.00).
In terms of efficacy, the postoperative UCVA at 6 months was better than or equal to the preoperative BCVA. No eye had postoperative UCVA less than the preoperative BCVA.
Regarding the refractive outcome, at the end of the follow up period, the spherical equivalent was less than 1.00D in 10 eyes, equal or more than 1.00 D in 2 eyes. No eye had a spherical equivalent of more than 1.5D at six months postoperatively.indicating high predictability of the procedure.
Regarding complications, three eyes needed selective suture removal for the reduction of with the rule astigmatism. Lens decentration occurred in one eye and inflammatory cell deposits on the IOL surface occurred in one eye.
No lens opacification, pupillary block, or retinal complications occurred during the follow-up period.
In conclusion, The present study revealed that Artisan phakic IOL had excellent results including., their suitability for high myopes , high optical quality, predictability, safety, efficacy, preservation of corneal architecture,
asphericity and accommodation. Moreover, correction is not limited by corneal thickness or topography.
This study did not reach the conclusion that a significant decrease in endothelial cell count occurs after an Artisan phakic lens implantation for the general population of high myopic eyes. A longer follow-up of those same patients would be very useful to determine the pIOL-related endothelial cell loss in the long term.
Despite all the concerns in endothelial cell loss, provided the patient is checked regularly, which must be an absolute prerequisite for this kind of surgery, the loss of endothelial cells is a foreseeable complication and may be corrected before more serious advanced complications may occur.