To evaluate long-term endothelial cell changes in phakic eyes that underwent implantation of an angle-supported anterior chamber lens to correct myopia.

A retrospective analysis was performed in 110 eyes of 55 patients who underwent implantation of angle-supported anterior chamber lenses with a follow-up period longer than 5 years. Comparisons were made between preoperative and postoperative endothelial cell density, coefficient of variation, and percentage of hexagonal cells.

Mean preoperative corneal endothelial cell density was 2951 ± 336 cells/mm² and the percentage of cell loss was 3.8% at year 1, 12.6% at year 3, 13.4% at year 5, 22.5% at year 7, and 22.2% at year 9. Explantation was required in 13 eyes (11.8%) due to the decrease of endothelial cell count to 936 ± 458 cells/mm² over 9 years of follow-up.

Continuous endothelial cell loss was observed after implantation of angle-supported anterior chamber lens in the long-term follow-up. A constant decline in the endothelial cell density necessitates periodic ophthalmologic evaluation including specular microscopy.