{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T15:09:55Z","timestamp":1780412995723,"version":"3.54.1"},"reference-count":12,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Ophthalmol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>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\u00a0mm) 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12886-026-04899-2","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T14:27:01Z","timestamp":1780410421000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Late-onset bullous keratopathy after iris-fixated phakic intraocular lens implantation: a case report"],"prefix":"10.1186","volume":"26","author":[{"given":"Salmaan","family":"Ferrand","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Bogdanova-Bennett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel T.","family":"Cornelius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashida Abbas","family":"Ferrand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"issue":"11","key":"4899_CR1","doi-asserted-by":"publisher","first-page":"1976","DOI":"10.1016\/j.jcrs.2010.08.014","volume":"36","author":"JL Guell","year":"2010","unstructured":"Guell JL, Morral M, Kook D, Kohnen T. Phakic intraocular lenses part 1: historical overview, current models, selection criteria, and surgical techniques. J Cataract Refract Surg Nov. 2010;36(11):1976\u201393. https:\/\/doi.org\/10.1016\/j.jcrs.2010.08.014.","journal-title":"J Cataract Refract Surg Nov"},{"issue":"12","key":"4899_CR2","doi-asserted-by":"publisher","first-page":"2168","DOI":"10.1016\/j.jcrs.2010.10.007","volume":"36","author":"T Kohnen","year":"2010","unstructured":"Kohnen T, Kook D, Morral M, Guell JL. Phakic intraocular lenses: part 2: results and complications. J Cataract Refract Surg Dec. 2010;36(12):2168\u201394. https:\/\/doi.org\/10.1016\/j.jcrs.2010.10.007.","journal-title":"J Cataract Refract Surg Dec"},{"key":"4899_CR3","doi-asserted-by":"publisher","unstructured":"Fechner PU, Wichmann W. Correction of myopia by implantation of minus optic (Worst Iris Claw) lenses into the anterior chamber of phakic eyes. Eur J Implant Refract Surg. 1993;5(1):55-59. https:\/\/doi.org\/10.1016\/S0955-3681(13)80064-0.","DOI":"10.1016\/S0955-3681(13)80064-0"},{"issue":"8","key":"4899_CR4","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1016\/s0886-3350(98)80096-5","volume":"24","author":"JL Menezo","year":"1998","unstructured":"Menezo JL, Cisneros AL, Rodriguez-Salvador V. Endothelial study of iris-claw phakic lens: four year follow-up. J Cataract Refract Surg Aug. 1998;24(8):1039\u201349. https:\/\/doi.org\/10.1016\/s0886-3350(98)80096-5.","journal-title":"J Cataract Refract Surg Aug"},{"issue":"6","key":"4899_CR5","doi-asserted-by":"publisher","first-page":"1002","DOI":"10.1016\/j.ophtha.2007.08.022","volume":"115","author":"JL Guell","year":"2008","unstructured":"Guell JL, Morral M, Gris O, Gaytan J, Sisquella M, Manero F. Five-year follow-up of 399 phakic Artisan-Verisyse implantation for myopia, hyperopia, and\/or astigmatism. Ophthalmol Jun. 2008;115(6):1002\u201312. https:\/\/doi.org\/10.1016\/j.ophtha.2007.08.022.","journal-title":"Ophthalmol Jun"},{"key":"4899_CR6","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1016\/j.ajo.2018.07.015","volume":"194","author":"SMR Jonker","year":"2018","unstructured":"Jonker SMR, Berendschot T, Ronden AE, Saelens IEY, Bauer NJC, Nuijts R. Five-Year Endothelial Cell Loss After Implantation With Artiflex Myopia and Artiflex Toric Phakic Intraocular Lenses. Am J Ophthalmol Oct. 2018;194:110\u20139. https:\/\/doi.org\/10.1016\/j.ajo.2018.07.015.","journal-title":"Am J Ophthalmol Oct"},{"issue":"4","key":"4899_CR7","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1016\/j.ophtha.2017.08.011","volume":"125","author":"SMR Jonker","year":"2018","unstructured":"Jonker SMR, Berendschot T, Ronden AE, Saelens IEY, Bauer NJC, Nuijts R. Long-Term Endothelial Cell Loss in Patients with Artisan Myopia and Artisan Toric Phakic Intraocular Lenses: 5- and 10-Year Results. Ophthalmol Apr. 2018;125(4):486\u201394. https:\/\/doi.org\/10.1016\/j.ophtha.2017.08.011.","journal-title":"Ophthalmol Apr"},{"issue":"12","key":"4899_CR8","doi-asserted-by":"publisher","first-page":"882","DOI":"10.1097\/OPX.0000000000002082","volume":"1","author":"MJ Roig-Revert","year":"2023","unstructured":"Roig-Revert MJ, Arias-Garcia E, Ortega-Perez C, Peris-Martinez C. Case Report: Role of Anterior Segment Optical Coherence Tomography for Managing Failed Endothelial Keratoplasty Graft. Optom Vis Sci Dec. 2023;1(12):882\u20136. https:\/\/doi.org\/10.1097\/OPX.0000000000002082.","journal-title":"Optom Vis Sci Dec"},{"issue":"3","key":"4899_CR9","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1016\/j.jcrs.2007.10.030","volume":"34","author":"M Kim","year":"2008","unstructured":"Kim M, Kim JK, Lee HK. Corneal endothelial decompensation after iris-claw phakic intraocular lens implantation. J Cataract Refract Surg Mar. 2008;34(3):517\u20139. https:\/\/doi.org\/10.1016\/j.jcrs.2007.10.030.","journal-title":"J Cataract Refract Surg Mar"},{"issue":"3","key":"4899_CR10","doi-asserted-by":"publisher","first-page":"NP13","DOI":"10.1177\/11206721231213684","volume":"34","author":"B Mergen","year":"2024","unstructured":"Mergen B, Berger T, Hamon L, Daas L, Seitz B. Anterior chamber intraocular lens removal combined with triple DMEK: Quadruple DMEK for bullous keratopathy. Eur J Ophthalmol. 2024;34(3):NP13\u20137. https:\/\/doi.org\/10.1177\/11206721231213684.","journal-title":"Eur J Ophthalmol"},{"issue":"6","key":"4899_CR11","doi-asserted-by":"publisher","first-page":"1133","DOI":"10.1016\/j.ophtha.2006.09.029","volume":"114","author":"NG Tahzib","year":"2007","unstructured":"Tahzib NG, Nuijts RM, Wu WY, Budo CJ. Long-term study of Artisan phakic intraocular lens implantation for the correction of moderate to high myopia: ten-year follow-up results. Ophthalmol Jun. 2007;114(6):1133\u201342. https:\/\/doi.org\/10.1016\/j.ophtha.2006.09.029.","journal-title":"Ophthalmol Jun"},{"issue":"1","key":"4899_CR12","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1016\/j.ophtha.2016.09.034","volume":"124","author":"S MacRae","year":"2017","unstructured":"MacRae S, Holladay JT, Hilmantel G, et al. Special Report: American Academy of Ophthalmology Task Force Recommendations for Specular Microscopy for Phakic Intraocular Lenses. Ophthalmol Jan. 2017;124(1):141\u20132. https:\/\/doi.org\/10.1016\/j.ophtha.2016.09.034.","journal-title":"Ophthalmol Jan"}],"container-title":["BMC Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12886-026-04899-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12886-026-04899-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12886-026-04899-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T14:27:01Z","timestamp":1780410421000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12886-026-04899-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,2]]},"references-count":12,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4899"],"URL":"https:\/\/doi.org\/10.1186\/s12886-026-04899-2","relation":{},"ISSN":["1471-2415"],"issn-type":[{"value":"1471-2415","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,2]]},"assertion":[{"value":"22 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"According to the policies of our institution and national regulations, formal ethics committee approval was not required for this single-patient case report, as all investigations and treatments were part of routine clinical care and the patient was managed according to standard practice.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"was obtained in writing from the patient to use the relevant details for this case report. A copy of the consent form is available for review by the Editor of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Patient consent"}},{"value":"What Was Known - Corneal Decompensation is a recognized complication of anterior chamber phakic intraocular lens implantation. To the Authors\u2019 knowledge, there has only been one other case report of endothelial decompensation requiring an AC pIOL explantation and a subsequent DMEK more than a decade after AC pIOL implantation. What This Paper Adds - This paper reports the development of bullous keratopathy requiring a keratoplasty as a complication of anterior chamber phakic intraocular lens implantation, occurring more than a decade after the original refractive correction procedure, which is a longer onset than what has been reported in other studies and case reports. The long timeframe within which this complication can occur emphasizes the need for careful patient counselling and regular lifelong monitoring with annual specular microscopy post-operatively. This report also provides insight into the management of severe bullous keratopathy in a patient with iris-fixated anterior chamber phakic intraocular lenses.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Value statement"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"301"}}