Implantation Of Capsular Tension Ring During Routine Phacoemulsification Surgery – Single Centre Analysis Moorfields Eye Hospital

A capsular tension ring (CTR) is designed to maintain the contour of the capsular bag during and after cataract removal. Over the years, CTR implantation is becoming increasingly common with multiple types of design and insertion techniques. Common indications for CTR in the literature include zonular weakness, dense cataracts and pseudoexfoliation syndrome. Standardised guidelines for CTR insertion, and the decision to implant intraoperatively is determined by the individual surgeon. The aim of this audit was to assess the rates of capsular tension ring insertion across all Moorfields Eye Hospital sites in London over a 10-year period. Sub-analysis on the indications and associated factors was also conducted.

Ophthalmology department at Moorfields Eye Hospital, the largest tertiary referral hospital in London.

All patients that underwent routine phacoemulsification and intraocular lens insertion at Moorfields Eye Hospital and required a capsular tension ring insertion between the dates of 01/01/2014 to 31/12/2024 were included in this study. Patients requiring additional surgery (corneal grafts, glaucoma implants) were excluded. OpenEyes database and software was used to extract and collate the data. Sub-analysis was conducted on the patient demographic data including age, gender, co-morbidities. Lens type and power were extracted from the OpenEyes operation note. Additional risk factors and challenges intraoperatively were extracted from free text notes. Results were analysed using SPSS statistical software (Version 18.0, IBM, Armonk, NY, USA).

4469 patients (2343 female, 2127 males) underwent CTR insertion during their routine phacoemulsification and intraocular lens insertion, over the 10 year period at Moorfields Eye Hospital. 16 patients were excluded from the analysis as they had undergone complex glaucoma shunts and corneal graft procedures at the same time.  The City Road site was noted to have the highest rate of CTR insertion (2322/4470). There was a gradual increase in CTR insertion from 132 cases in 2014, to 597 in 2024 (with the highest rates noted in 2022 – 699). Average lens power insertion 18.8. Common risk factors for CTR insertion included zonular dehiscence noted during surgery, high myopia, floppy iris, mature cataract, trauma and pseudoexfoliation syndrome.

Frequency of CTR insertion has increased gradually over the years, this is likely due to greater understanding and recognition of its use as well as a generalised increase in the complexity of cataracts operated in tertiary units. Although there are no fixed guidelines, CTR implantation is commonly indicated for patients with known risk factors of mature cataracts, trauma, pseudoexfoliation and intraoperative zonular dehiscence. Timely recognition of its need is key to ensuring better surgical and visual outcomes.