Do You Have to Remove the Lens 10 Years After Implantable Contact Lens (ICL) Surgery? (2025)
Written by Apgujeong Eye Clinic
2025.02.20
According to some studies, posterior Lens Implantation Surgery(ICL) does not significantly reduce corneal endothelial cells even after 10 years. On the other hand, online communities often claim that the lens must be removed after 10 years due to endothelial cell loss. What could be the reason for this discrepancy?
What Are Endothelial Cells?
The cornea consists of five layers, from the outermost to the innermost: corneal epithelium, Bowman's membrane, corneal stroma, Descemet's membrane, and corneal endothelium. Among these, the corneal endothelial cells, located at the innermost layer, have a density of approximately 3,000 cells per mm² at birth. As a person ages, these cells gradually deteriorate, naturally decreasing at a rate of about 0.6% per year.
Importance of Endothelial Cells
Corneal endothelial cells do not regenerate, so it is crucial to prevent their reduction. These cells play a vital role in supplying nutrients to the cornea and regulating corneal hydration to maintain its transparency. If endothelial cells decrease significantly, the cornea loses its ability to regulate moisture, leading to corneal edema, opacity, and vision deterioration. Since some individuals may have fewer endothelial cells due to congenital factors or external influences, a pre-surgical examination to assess endothelial cell density is essential before undergoing any eye surgery.
Relationship Between Lens Implantation and Endothelial Cells
In the past, anterior chamber lens implantation was commonly performed by making an incision in the iris to fix the lens in place. However, in this procedure, the lens was positioned very close to the corneal endothelium, increasing the risk of endothelial cell loss over time. Although rare, in some cases, this led to the necessity of lens removal due to excessive endothelial cell damage. In contrast, the EVO+ Aqua ICL procedure uses posterior chamber lens implantation, where the lens is placed between the iris and the natural crystalline lens. Since the lens does not come into direct contact with the corneal endothelium, unlike anterior chamber lens implantation, the risk of endothelial cell damage is significantly reduced.
Check Point
Even though posterior chamber lens implantation (ICL) has a low risk of endothelial cell loss, it is recommended to have a regular check-up at least once a year to ensure the corneal endothelium remains stable. ICL lens implantation is recognized as a highly safe procedure, but it also requires a high level of surgical expertise. If you are considering the procedure, it is advisable to consult a certified ICL doctor who has been officially recognized by STAAR, a global leader in implantable lenses, for their extensive clinical experience and surgical proficiency.
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