Capsular Tension Rings Reduce IOL Decentration in Highly Myopic Eyes Over 30 mm, claims JAMA study
Researchers have demonstrated that capsular tension rings (CTRs) can indeed significantly reduce intraocular lens (IOL) decentration and tilt in highly myopic eyes, inclusive of cases in which the axial length (AL) is equal to or greater than 30 mm. A recent study published in JAMA Ophthalmology was conducted by Lin and colleagues.
In this clinical trial, there were 186 patients with cataracts whose AL was 26 mm or more. All the patients were further divided into three strata according to AL: stratum 1 (26 mm≤AL<28 mm), stratum 2 (28 mm≤AL<30 mm), and stratum 3 (AL≥30 mm). Randomization was carried out by assigning half of the patients in each stratum to the CTR group with a combination of a C-loop IOL with a CTR and the remaining half to the control group with only a C-loop IOL. The principal outcome measure was IOL decentration, which was assessed at 3 months post-surgery by anterior segment optical coherence tomography.
Results
Of the 186 eyes that were included in this study 93 eyes (50%) belonged to the CTR group, and 93 eyes (50%) belonged to the control group. 87 eyes in the CTR group and 92 eyes in the control group were seen for follow-up at a minimum of 3 months after cataract surgery.
The authors reported that, compared with the CTR group at 3 months post cataract surgery, IOL decentration and tilt were smaller in the control group (difference, −0.04 mm; 95% CI, −0.07 to −0.01 mm; p =0 .02).
This trend was greater in eyes with an AL of 30 mm or more. In that subgroup, IOL decentration was significantly smaller in the CTR group than in controls (0.20 mm vs 0.28 mm; difference, −0.08 mm; 95% CI, −0.14 to −0.02 mm; p= 0.01).
Also, clinically significant IOL decentration (≥0.4 mm) and tilt (≥7°) were lower at 3 months in the CTR group compared with the control group. In eyes with AL less than 30 mm, there was no difference in results between the CTR and control groups.
Capsular tension rings demonstrated a reduction in IOL decentration, increased position stability, and better visual quality in eyes with greater than or equal to 30 mm of AL. This study provides important clues for ophthalmic surgeons in optimizing surgical outcomes for patients with high myopia. Further studies should look into the long-term results of the use of CTR on the quality of vision and patient satisfaction with their outcomes.
Reference:
Lin, H., Zhang, J., Zhang, Y., Jin, A., Zhang, Y., Jin, L., Xu, Y., Xie, X., Tan, X., Luo, L., & Liu, Y. (2024). Capsular tension ring implantation for intraocular lens decentration and tilt in highly myopic eyes: A randomized clinical trial. JAMA Ophthalmology, 142(8), 708. https://doi.org/10.1001/jamaophthalmol.2024.2215
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