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

Claudia Tribus¹, Claudia S Alge¹, Christos Haritoglou¹, Carlo Lackerbauer¹, Anselm Kampik¹, Arthur Mueller², Siegfried G Priglinger¹

¹Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany; ²Department of Ophthalmology, Zentralklinikum Augsburg, Germany

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: capsular tension ring, mature cataract, PEX, cataract surgery, IOL luxation