The corneal endothelium is a single layer of specialised cells that maintains corneal clarity by regulating fluid balance. These cells do not regenerate, making long-term preservation essential for eye health. ¹ Monitoring endothelial cell density is therefore a key safety measure after ICL surgery.
Modern ICLs are positioned behind the iris and are designed to minimise corneal interaction. Long-term studies show that endothelial cell loss after ICL implantation is typically comparable to normal age-related decline when sizing and vault are appropriate. ² However, subtle cell loss can occur without symptoms, which is why specular microscopy is used even when vision feels excellent.
Most clinics measure endothelial cell counts before surgery, then repeat testing around one year post-operatively. If results are stable, monitoring intervals may be extended. Patients with high myopia, shallow anterior chambers, or borderline pre-operative counts are usually followed more closely. ²
Although rarely discussed by patients, this monitoring is central to ensuring that ICLs remain safe over decades rather than just the early postoperative years. Early detection allows proactive management long before visual function is affected. ¹
References
- Bourne WM. Biology of the corneal endothelium in health and disease. Eye (Lond). 2003;17(8):912–918.
- Alfonso JF, Lisa C, Abdelhamid A, Fernandes P, Jorge J, Montes-Micó R. Long-term evaluation of endothelial cell changes after posterior chamber phakic intraocular lens implantation. Am J Ophthalmol. 2014;157(3):573–581.
Related Topics
- Life After ICL: Why Clear Vision Isn’t the End of the Story
- Can Myopia Still Progress in Adulthood After ICL Surgery, and How Does That Affect Long-Term Vision?
- Why Are Endothelial Cell Counts Monitored After ICL Surgery, and How Often Should They Be Checked?
- What Is ICL Vault, and Why Is It Critical for Protecting the Eye Long Term?
- Is Gradual Vision Change Years After ICL Surgery Normal, and When Should It Be Investigated?
- When Is Laser Enhancement Appropriate After ICL Surgery, and When Is It the Wrong Tool?
- In Your 40s, Is ICL or Lens Replacement More Stable Over the Long Term?
- How Do Modern Clinics Calculate IOL Power Accurately in Eyes That Previously Had ICL Surgery?
- How Accurate and Stable Are Toric Trifocal Lenses After ICL Removal?
- Why Do Two Separate Consultations Improve Safety After ICL?
- Why Should High Myopes Plan Vision Correction Across Decades?
