Comparison of Capsular Tension Ring Implantation before vs. after Toric Intraocular Lens for Rotational Stability

Abstract

Purpose To compare the effect of implanting the capsular tension ring (CTR) before or after a toric intraocular lens (IOL) on rotational stability in patients with cataract and astigmatism.

Methods This is a randomized retrospective study. Patients who underwent phacoemulsification combined with toric IOL implantation due to cataract and astigmatism between February 2018 and October 2019 were enrolled in the study. Group 1 consisted of 53 eyes of 53 patients in whom the CTR was placed into the capsular bag after the implantation of the toric IOL. On the other hand, group 2 consisted of 55 eyes of 55 patients in whom the CTR was placed into the capsular bag before implantation of the toric IOL. The two groups were compared in terms of preoperative and postoperative astigmatism, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and postoperative IOL rotation degree.

Results There were no significant differences between the two groups related to age and sex (p > 0.05) or the mean preoperative spherical value, UCVA, BCVA, and corneal astigmatism (p > 0.05). Although the mean postoperative residual astigmatism of the first group (− 0.29 ± 0.26) was lower than that of the second (− 0.43 ± 0.31), the difference was not statistically significant (p = 0.16). The mean degree of rotation was 0.75 ± 2.66° in group 1 and 2.90 ± 6.57° in group 2, which was found to be statistically significant (p = 0.02).

Conclusion The implantation of CTR after a toric IOL provides further rotational stability and more effective astigmatic correction.

Zusammenfassung

Ziel Es sollte die Auswirkung der Implantation des Kapselspannrings (CTR) vor oder nach der torischen Intraokularlinse (IOL) auf die Rotationsstabilität bei Patienten mit Katarakt und Astigmatismus verglichen werden.

Methoden Diese Studie ist eine randomisierte retrospektive Studie. Patienten, die sich zwischen Februar 2018 und Oktober 2019 einer Phakoemulsifikation in Kombination mit einer torischen IOL-Implantation aufgrund von Katarakt und Astigmatismus unterzogen, wurden in die Studie aufgenommen. Gruppe 1 bestand aus 53 Augen von 53 Patienten, bei denen die CTR nach Implantation der torischen IOL in den Kapselsack eingebracht wurde. Andererseits bestand Gruppe 2 aus 55 Augen von 55 Patienten, bei denen die CTR vor der Implantation der torischen IOL in den Kapselsack eingebracht wurde. Beide Gruppen wurden in Bezug auf präoperativen und postoperativen Astigmatismus, unkorrigierten Visus (UCVA), bestkorrigierten Visus (BCVA) und postoperativen IOL-Rotationsgrad verglichen.

Ergebnisse Es gab keine signifikanten Unterschiede zwischen den beiden Gruppen in Bezug auf Alter und Geschlecht (p > 0,05) oder den mittleren präoperativen sphärischen Wert, UCVA, BCVA und Hornhautastigmatismus (p > 0,05). Obwohl der mittlere postoperative Restastigmatismus der 1. Gruppe (− 0,29 ± 0,26) niedriger war als der der 2. (− 0,43 ± 0,31), war der Unterschied statistisch nicht signifikant (p = 0,16). Der mittlere Rotationsgrad betrug 0,75 ± 2,66° in Gruppe 1 und 2,90 ± 6,57° in Gruppe 2, was statistisch signifikant war (p < 0,001).

Schlussfolgerung Die Implantation von CTR nach der torischen IOL sorgt für weitere Rotationsstabilität und effektivere astigmatische Korrektur.

Conclusion Box

Already known:

• Postoperative toric IOL rotation is the main factor responsible for nonoptimal visual outcomes after toric IOL implantation.

• To prevent the IOL axis rotation, the CTR can be implanted before the toric IOL, as it can provide stability and prevent rotation.

• However, implantation of the CTR before the toric IOL cannot eliminate the toric IOL rotation.

Newly described:

• The implantation of the CTR after the toric IOL provides further rotational stability. Furthermore, this method provides greater IOL stabilization than the conventional method (CTR implantation before the toric IOL), even in eyes with a long AL.

• In this method, the CTR overpresses the toric IOL haptics and increases the friction between the capsular bag and the IOL haptics, and it provides much more toric IOL stability.

Key words

CTR - toric IOL - cataract - astigmatism - postoperative rotation

Schlüsselwörter

CTR - torische IOL - Katarakt - Astigmatismus - postoperative Rotation

Publication History

Received: 26 April 2022

Accepted: 12 October 2022

Article published online:
16 February 2023

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