Capsular tension ring implantation may enhance results of accommodating IOL

Better stability, durability and predictability can result, according to two surgeons.

BUDAPEST — The accommodating Crystalens HD IOL performs better with simultaneous implantation of a capsular tension ring, according to two surgeons at the winter meeting of the European Society of Cataract and Refractive Surgeons.

Erik Mertens, MD, FEBOphth, said a capsular tension ring (CTR) “improves the stability of the capsule, thus optimizing the performance of the lens and creating the best conditions for long-term durability.”

In a study, Dr. Mertens evaluated the safety and efficacy of using a CTR in refractive lens exchange with implantation of a Crystalens HD (Bausch + Lomb).

Fifty-six eyes of 28 patients underwent IOL implantation under topical anesthesia. All eyes were implanted with the Crystalens HD and received a capsular tension ring (10/12 mm, Ophtec). All patients were followed for at least 6 months.

Monocular uncorrected near vision was J1 or better in 22% of cases and J3 or better in 82%. Binocularly, 43% of the patients were able to read J1 and 100% were J3 or better. Monocular uncorrected intermediate vision was J1 or better in 72% and J2 or better in 88% of cases. Binocular uncorrected intermediate vision was J1 or better in 90% and J2 or better in 92%.

Injection of capsular tension ring in the capsular bag. Image: Mertens E

“The use of CTR in Crystalens HD implantation resulted in stable refractive results and a high level of spectacle independence. Ninety-one percent of the patients reported to never wear glasses for distance vision, 85% don’t wear them for near and 79% are completely independent of spectacles,” Dr. Mertens said.

In a similar group of 31 patients implanted with the Crystalens HD without a CTR, 47% of patients were completely spectacle independent.

“Distance vision was not significantly different in the group of patients without CTR, but both intermediate and near vision in the CTR group were better. Predictability also improved significantly with respect to cases where no CTR was used,” he said. “I would like to encourage colleagues to start using capsular tension rings in future Crystalens HD implantations.”

Another set of results

Kristien Vanhoucke, MD, said she also uses capsular tension rings with the Crystalens HD IOL. She recommended careful positioning of the lens in the posterior part of the capsular bag. If the lens is not folded well posteriorly at the end of surgery, an air bubble can be injected, she said.

Dr. Vanhoucke presented the results of 30 eyes implanted with the Crystalens HD and a CTR. Her case series included 22 refractive lens exchange procedures and two eyes that had previously undergone LASIK. Twenty-six eyes had a follow-up of at least 6 months.

The mean postoperative spherical equivalent was –0.19 D, and mean cylinder was 0.03 D. Monocular uncorrected distance visual acuity at 6 months was 20/25 or better in 88% of the eyes and 20/20 or better in 44% of the eyes. Monocular uncorrected intermediate visual acuity was 20/25 or better in 99% of the eyes and 20/20 or better in 95% of the eyes. Monocularly, 92% of the patients read J2 or better, and 64% read J1 or better.

“Looking at the binocular function index, which is the average of distance, intermediate and near vision, we see that 95% of the eyes achieved 20/25 or better, and 89% achieved 20/20 or better,” Dr. Vanhoucke said.

“These results show immediately how good vision is at all distances. Spectacle independence was achieved in 90% of cataract and refractive patients,” she said. – by Michela Cimberle

• Erik L. Mertens, MD, FEBOphth, can be reached at Medipolis Eye Center, Boomsesteenweg 223, B-2610 Wilrijk, Belgium; +32-38282949; fax: +32-38208891; e-mail: e.mertens@medipolis.be.
• Kristien Vanhoucke, MD, can be reached at Oogkliniek, Jacob Smitslaan 9a, 2400 Mol, Belgium; +32-14321020; fax: +32-14321280; e-mail: dr.vanhoucke@scarlet.be.

Capsular tension rings (CTRs) can indeed assist in stabilizing IOLs. As reported in previous studies (including our own study on multifocal lenses with and without CTR implantation), they can be especially useful in specific design lenses, such as plate haptic multifocal diffractives.

Plate haptic lenses cannot compensate for capsular bag retraction. They may be more prone to tilt and are very sensitive to any optical imbalance — and the consequent increase in induced aberrations and decrease in optical quality performance — due to postoperative contraction of the capsular bag.

It is therefore not surprising that the Crystalens gains some benefit from the use of CTRs. By helping to stabilize the lens, CTRs improve its outcomes.

The clinical impact of this report and our study is clear: Capsular tension rings could be an excellent adjuvant with premium IOLs, especially those with a plate haptic design.

This topic really deserves a multicenter, prospective study, as it could become an important issue in the future of premium IOL plate haptic design.

– Jorge L. Alió, MD, PhD
OSN Europe Edition Editorial Board Member

Reference:

• Alió JL, Elkady B, Ortiz D, Bernabeu G. Microincision multifocal intraocular lens with and without a capsular tension ring: optical quality and clinical outcomes. J Cataract Refract Surg. 2008;34(9):1468-1475.