Long-Term Outcomes Of In-The-Bag Single-Piece Versus Optic Capture Three-Piece Intraocular Lenses Following Capsular Tension Ring Implantation In Zonular Weakness

To compare the clinical outcomes, intraocular lens (IOL) stability, and complication profiles between in-the-bag single-piece IOL implantation and optic capture three-piece IOL implantation following capsular tension ring (CTR).

This retrospective comparative study was conducted at a tertiary eye care center in 70 eyes of 70 patients who underwent phacoemulsification cataract surgery with CTR implantation due to zonular weakness between January 2015 and December 2020.

Patients were divided into two groups: those who received three-piece IOL implantation with the optic capture technique (Group 1) and those who received in-the-bag single-piece IOL implantation (Group 2). Preoperative and final postoperative evaluations included uncorrected (UCVA) and best-corrected visual acuity (BCVA), intraocular pressure (IOP), refractive outcomes, endothelial cell density (ECD), and corneal thickness (CT). Early and late postoperative complications were also recorded. Corneal, lenticular and total ocular aberrations, dysfunctional lens index, modulation transfer function, and Strehl ratio were assessed using the iTrace wavefront aberrometer at the final postoperative visit.

Mean follow-up time was 81.8 ± 18.3 months. Postoperative UCVA and BCVA were comparable between groups (p=0.418 and p=0.210, respectively) and improved significantly in each group (all p<0.001). IOP remained stable (Group 1 p=0.726; Group 2 p=0.266). Refractive outcomes were similar between groups (all p>0.05). ECD showed a significant decrease in both groups (all p<0.001), whereas CT decreased only in Group 1 (p=0.019). IOL dislocation occurred in 8.8% in Group 1 and 11.1% in Group 2, with longer time to dislocation in Group 1 (71.3 ± 24.8 months) compared to Group 2 (52 ± 30.8 months). Wavefront analysis revealed no intergroup differences (all p>0.05); however, lenticular spherical aberration was significantly higher in Group 2 (p=0.049).

Both surgical techniques appear safe and provide comparable long-term visual and refractive outcomes in eyes with zonular weakness. The longer time to IOL dislocation observed with the optic capture technique may indicate a potential advantage in long-term stability. Surgical decision-making should be individualized based on zonular status, patient characteristics, and the feasibility of long-term follow-up.