Impact Of A Capsular Tension Ring On Decentration And Tilt Of A Plate Haptic Intraocular Lens – An Intraindividual Comparative Study

To assess the impact of a commonly used capsular tension ring (CTR) on decentration and tilt of a plate haptic hydrophilic intraocular lens (IOL) 

Medical University of Vienna, Department of Ophthalmology and Optometry 

In this prospective, randomized, controlled study 130 eyes of 65 patients with bilateral age-related cataract were included.  Randomized, one eye of every patient received a capsular tension ring Model 276 (Ophtec B.V., Groningen, Netherlands) (CTR-group) and a hydrophilic acrylic intraocular lens CT Asphina 409MP (Carl Zeiss, Jena, Germany) whereas the fellow eye received the CT Asphina 409MP IOL only (Control-group). Decentration and tilt values were assessed preoperatively (crystalline lens), 1 week (1w) and 6 months (6m) after surgery using an anterior segment SS-OCT Casia 2 (Tomey Corp., Nagoya, Japan). Results are presented as mean±SD and range [Min;Max]. 

Mean decentration at 6m with respect to the corneal vertex was 0.28±0.15[0.04;0.78] mm for the CTR-group and 0.24±0.12[0.05;0.61] mm for the Control-group, respectively (p=0.058). More IOLs were decentered more than 0.5mm in the CTR-group compared to the Control-group (10% vs.3.3%). Difference in mean decentration from preoperative to 6m was 0.29±0.15[0.05;0.75] mm for the CTR-group and 0.18±0.11[0.02;0.51] mm for the Control-group, respectively (p<0.01). Mean tilt at 6m was 6.66±2.77[1.5;17.7] degree for the CTR-group and 5.55±1.60[2.50;9.20] degree for the Control-group, respectively (p<0.01). Difference in mean tilt from preoperative to 6m was 3.3±2.8[0.1;12.4] degree and 1.6±1.1[0.1;4.6] degree, respectively(p<0.01).  

Previously, CTRs were propagated to improve centration and minimize IOL tilt after cataract surgery. In our study, the implantation of a capsular tension ring in combination with a 11.0mm plate haptic IOL had a negative impact on postoperative centration and tilt. Significantly more IOLs were decentered and tilted in the CTR-group compared to the no CTR Control-group. The use of a capsular tension ring in combination with a hydrophilic plate haptic IOL at the time of cataract surgery should be considered with care.