A retrospective study of the indications and outcomes of capsular tension ring insertion during cataract surgery at a tertiary teaching hospital

Abstract

BackgroundThe purpose was to determine preoperative indications, intraoperative procedures, and outcomes of capsular tension ring (CTR) insertion during cataract surgery.MethodsA review of all patients undergoing cataract surgery with insertion of a CTR between July 2000 and June 2010 was conducted at The Royal Victorian Eye and Ear Hospital, a large tertiary teaching hospital in Victoria, Australia. Information relating to each patient’s demographic details, preoperative assessment, surgical procedure, and postoperative assessment were obtained.ResultsEighty-four eyes of 82 patients were included in this study. The main indications for CTR insertion were previous trauma, pseudoexfoliation syndrome, and mature cataracts. Twenty-one eyes (25.0%) did not have any obvious preoperative indication. A posterior capsule tear was the most common intraoperative complication (3.6%). An intraocular lens was successfully implanted in the bag in 72 eyes (85.7%). Postoperatively, the most common complications were a decentered intraocular lens (8.3%) and persistent corneal edema (6.0%). Overall, 61 eyes (72.6%) had better postoperative visual acuity compared with preoperative acuity, with 67 patients (79.8%) achieving vision of 20/40 or better.ConclusionFor the majority of cases, CTR use in complex cataract surgeries is associated with improved postoperative outcomes. CTR implantation is most commonly required in patients with known risk factors for zonular instability.

The efficacy of lens removal plus IOL implantation for the treatment of spherophakia with secondary glaucoma

“…Early studies have shown that CTR can improve capsular stability and maintain postoperative IOL centration in the setting of mild zonular weakness,11 12 as demonstrated in the present study in which IOLs were well centred in five of seven eyes (71.4%). However, CTR does not work well in the setting of seriously impaired zonules in spherophakia, whereas scleral-fixated IOL is an optimal alternative.…”

Intraoperative difficulties, complications and self‐assessed visual function in cataract surgery

“…Limited knowledge exists about the visual outcomes of cataract surgery involving CTRs. One Australian study of 84 eyes in which CTRs were inserted intraoperatively reported that compared to the preoperative VA, 73% had a better postoperative VA, 20% remained unchanged and 7% had worse postoperative VA (Wang et al 2013). The Australian study did not report comparative data on eyes without CTR insertion intraoperatively.…”

“…A small pupil, intraoperative floppy iris syndrome (IFIS), a white cataract with no visible red reflex, zonular weakness and an instable capsular bag are difficulties that can be identified. Previous studies and clinical experience have shown that a small pupil or IFIS (Chang & Campbell 2005;Vollman et al 2014;Hashemi et al 2015;Ratra & Lam 2015), absence of a red reflex due to a white cataract (Jacob et al 2002) or an unstable capsular bag (Hasanee et al 2006;Blecher & Kirk 2008;Wang et al 2013;Weber & Cionni 2015) intraoperatively increase the risk of tissue damage and resultant complications. Adjunct devices such as capsular tension rings (CTRs), devices for mechanical stretching of the pupil and ophthalmic viscosurgical devices, trypan blue dye and capsular hooks are used in these challenging cases to improve the surgical outcomes.…”

“…; Blecher & Kirk ; Wang et al. ; Weber & Cionni ) intraoperatively increase the risk of tissue damage and resultant complications. Adjunct devices such as capsular tension rings (CTRs), devices for mechanical stretching of the pupil and ophthalmic viscosurgical devices, trypan blue dye and capsular hooks are used in these challenging cases to improve the surgical outcomes.…”

Outcome of phacoemulsification and intraocular lens implantion in eyes with pseudoexfoliation and weak zonules

“…; Wang et al. ), but reports on the postoperative outcome of CTR implantation in PEX eyes are scarce. Although we cannot extrapolate from our data, it is possible that CTR implantation may have a potential positive role in the intraocular management of zonular issues in eyes with PEX and may enhance safety of cortex removal, as CTR implantation was used in eyes with more extensive zonular weakness than in those eyes that did not receive a CTR.…”