Indications and clinical outcome of capsular tension ring (CTR) implantation: A review of 9528 cataract surgeries

Abstract

Background: To report the indications and clinical outcomes of all capsular tension ring (CTR) implantations in a large series of consecutive cataract surgeries during a five year interval in a university eye hospital.

Methods: The study was designed as a restrospective analysis of a consecutive series of 9528 cataract surgeries. The records were checked for cases in which a CTR was implanted. The indications and clinical outcomes of CTR implantation were documented and an evaluation of posterior chamber intraocular lens (PCIOL) insertion, position, and centration.

Results: In this series, a CTR was implanted in 69 eyes of 67 patients. The indications were advanced or mature cataract in 40, post-traumatic cataract in 23, pseudoexfoliation syndrome in 4 and subluxated lens in 2 eyes. PCIOL implantation in the capsular bag was possible in 61 (90%) of these 69 eyes. In 5 (7%) additional eyes, PCIOL implantation in the ciliary sulcus was accomplished. In one eye (1%) no IOL implantation was performed because of high myopia. In only two of 69 eyes (2%), an anterior chamber intraocular lens had to be inserted despite prior CTR implantation. In 5 eyes (5%), a slight dislocation of the IOL was noted postoperatively, but none of these patients complained of visually relevant symptoms (eg, monocular diplopia).

Conclusions: According to our experience CTRs are used very infrequently (0.7%), but remain useful in cataract surgeries with difficult preoperative or intraoperative conditions. If zonulolysis is less than two quadrants in extent, implantation of a PCIOL was possible in 98% of cases. Implantation of CTRs with special designs may have additional advantages (eg, inhibition of posterior capsule opacity) and warrant further investigation.

Keywords: IOL luxation; PEX; capsular tension ring; cataract surgery; mature cataract.

Figure 1

Morcher^® type 14 CTR (open diameter 12.5 mm)(down) and IOL (up). Abbreviations: CTR, capsular tension ring, IOL, intraocular lens.

Figure 2

UBM findings after CTR and IOL insertion (intraoperative zonulolysis over 4 clock hours) (Fries et al 1998). Notes: CTR (1), haptic of IOL (2), and IOL (3). Abbreviations: CTR, capsular tension ring, IOL, intraocular lens; UBM, ultrasound biomicroscopy.