To investigate long-term endothelial changes in phakic eyes implanted with iris-claw phakic intraocular lens (IOL) (Artisan® lens Ophtec, Groningen, Netherlands) and to identify the associated factors.

Thirty-one eyes of 18 patients underwent Artisan phakic IOL implantation and were followed up for over 1 year. The authors retrospectively examined the endothelial cell density, percentage of hexagonal cells and coefficient of variation using the result of non-contact specular microscope.

The mean endothelial cell loss was 0.9% at 23.9±9.44 months of the mean follow-up period. There was no statistically significant decrease in endothelial cell density ( p =0.445). There was no statistically significant change in pleomorphism and polymegathism of the endothelial cells after the surgery. There was no statistically significant correlation between endothelial cell loss and anterior chamber depth (r²=0.0488, p =0.377).

No clinically significant endothelial damage occurred after iris-claw phakic IOL implantation. However, special attention should be given to patients with shallow anterior chamber depth for iris-claw phakic IOL insertion to avoid unintended endothelial damage and long-term endothelial checkups using a specular microscope are critical for long-term protection of endothelial cells.