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Postoperative outcome of capsular tension ring implantation in eyes with pseudoexfoliation after cataract surgery

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Session Details

Session Title: Cataract Surgery Special Cases

Session Date/Time: Sunday 06/09/2015 | 10:30-12:30

Paper Time: 11:32

Venue: Room 10

First Author: : Y.Neo UK

Co Author(s): :    B. Shingleton                    

Abstract Details


To evaluate the postoperative outcome of non-sutured capsular tension ring (CTR) implantation in pseudoexfoliation (PEX) eyes with zonular weakness that underwent phacoemulsification with intraocular lens (IOL) implantation.


Ophthalmic Consultants of Boston, Center for Eye Research and Education, Boston, Massachusetts, USA


This prospective, single-surgeon study recruited three hundred and nineteen consecutive PEX eyes which underwent phacoemulsification cataract surgery: 53 showed signs of zonular weakness and received CTR implantation (Group A); 117 with signs of zonular weakness but without CTR implantation (Group B) and 148 non-CTR eyes with no signs of zonular weakness (Group C). Comparative analysis was performed with a 99% level of confidence. Primary outcome measures included the incidence of postoperative pseudophakodonesis (mild severity), anterior capsular contraction (moderate severity) and IOL decentration (severe). Postoperative vision, intraocular pressure (IOP) and glaucoma medication requirements (GMR) were also assessed.


Group A and B had a significantly higher risk of developing one or more postoperative complications (pseudophakodonesis, anterior capsular contraction and IOL decentration) than group C (p>0.01). There was, however, no significant difference between the risk of developing these complications between group A and B (p=0.68). The proportion of eyes which developed IOL decentration was similar in all groups (p<0.05). Mean follow up for all PEX eyes was 24.3±31.4 months. All three groups showed statistically significant improvement in both logMAR CDVA and mean reduction in IOP (p>0.001). None of the groups showed a significant difference in GMR (p=0.061).


There were similar complication rates between CTR and non-CTR implanted PEX eyes. Non-sutured CTR implantation itself does not prevent IOL and capsular complications postoperatively. In the absence of signs of zonular weakness, PEX eyes should still be addressed with caution as it relates to zonular issues that may complicate postoperative recovery. In PEX eyes with zonular weakness, CTR can prevent marked IOL decentration and tilt, and may lead to prevention of refractive prediction error.

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