Objective: To evaluate the two-year efficacy and stabilization of the capsular tension ring (CTR) in providing capsular support during phacoemulsification in cases of a weak or partially broken ciliary zonule.
Methods: This prospective study comprised 22 eyes of 19 patients with weakness or partially broken ciliary zonule preoperatively or intraoperatively. After insertion of a CTR, phacoemulsification with intraocular lens (IOL) implantation was performed. Patients were examined preoperatively and postoperatively at 1 day, 1 week, 1, 6, 12 and 24 months. The postoperative refractive status, intraocular pressure, the decentration of capsule/IOL complex, the degree of posterior capsular opacification (PCO) and capsular contraction were examined. The extent of IOL tilting and decentration was measured using Scheimpflug Videophotography System (Pentacam, Oculus) 1, 6, 12 and 24 months postoperatively.
Results: Twenty-four months results from this ongoing study indicated that the postoperative best corrected visual acuity improved 2 lines in 20 eyes, improved 1 lines in 2 eyes. In-the-bag fixation of CTR was achieved in 21 eyes (90.9%), CTR of 1 eye is out of capsule bag. IOL implanted was not centered in 1 eye 1 months after surgery and up to 5 eyes 24 months after the surgery. Nd: YAG laser capsulotomy was performed in 3 eyes (13.6%) by 24 months for severe PCO. The mean IOL decentration was (0.393 +/- 0.094), (0.406 +/- 0.094), (0.415 +/- 0.093) and (0.463 +/- 0.172) mm on 1, 6, 12 and 24 months postoperatively, respectively. Significant differences in IOL decentration was presented between 1 and 24 months postoperatively, also between 6 and 24 months. The mean IOL tilt was (2.637 +/- 0.369), (2.653 +/- 0.349), (2.682 +/- 0.348) and (2.714 +/- 0.360) degrees on 1, 6, 12 and 24 months postoperatively, respectively, which showed no statistically significant differences (P = 0.220) throughout the 24-month follow-up period.
Conclusions: CTR offers numerous advantages in situations of zonular insufficiency including reestablishment of the capsular bag contour, decrease of risk of PCO and limitation of late IOL decentration due to asymmetric capsule contraction.