Influence Of Capsular Tension Ring Insertion On The Refractive Outcomes After Phacoemulsification In Pseudoexfoliation Syndrome
Published 2026 - 44th Congress of the ESCRS
Reference: PP03.09 | Type: Free paper | DOI: 10.82333/h3s8-b114
Authors: Dr Georgios Chondrozoumakis* 1 , Dr Efstathios Vounotrypidis 2 , Dr Eleftherios Chatzimichail 3 , Prof. Zisis Gatzioufas 3 , Prof. Miltiadis Tsilimbaris 4 , Dr Emmanouil Christodoulakis 5
1Department of Ophthalmology ,University Hospital of Heraklion,Heraklion,Greece;Department of Ophthalmology ,General Hospital of Rethymnon,Rethymnon,Greece, 2Department of Ophthalmology ,Ulm University,Ulm,Germany, 3Department of Ophthalmology ,University Hospital of Basel,Basel,Switzerland, 4Department of Ophthalmology ,University Hospital of Heraklion,Heraklion,Greece, 5Department of Ophthalmology ,General Hospital of Rethymnon,Rethymnon,Greece
Purpose
To evaluate the influence of capsular tension ring (CTR) implantation on the refractive outcomes after uneventful cataract surgery in eyes with pseudoexfoliation syndrome (PEX).
Setting
Ophthalmology Department of the General Hospital of Rethymnon, Greece.
Methods
In this retrospective study, eyes with age-related cataract and PEX underwent standard phacoemulsification by a single experienced surgeon with in-the-bag implantation of an intraocular lens (IOL; CT LUCIA 621P or AcrySof SN60WF) and CTR implantation when indicated. Eyes were grouped as IOL only (Group A) or IOL with CTR (Group B). CTR insertion was decided intraoperatively in cases with evidence of loose zonules during capsulorhexis. IOL power was calculated using the Barrett Universal II formula. The primary outcome was refractive prediction error (PE); the secondary outcome was mean absolute error (MAE). Crude comparisons and adjusted analyses were performed, accounting for IOL model, axial length (AL) and anterior chamber depth (ACD).
Results
A total of 47 eyes of 43 patients were included, with 24 eyes receiving an IOL only (Group A) and 23 an IOL with CTR (Group B). PE was 0.14 ± 0.52 D in Group A and significantly higher in Group B at 0.67 ± 0.41 D, with a mean difference of 0.54 D (95% CI, 0.26–0.84, p < 0.001). In the adjusted analysis, CTR remained an independent predictor of hyperopic PE (p < 0.001), whereas the IOL model factor and the covariates AL and ACD were not significant (all p > 0.10). No significant interaction between CTR use and IOL model was detected (p = 0.995). Similarly, MAE was 0.44 ± 0.30 D in Group A and 0.68 ± 0.41 D in Group B (p = 0.027).
Conclusions
CTR implantation seems to induce a mild hyperopic shift of about a half diopter, which should be taken into consideration when calculating the IOL power in patients with PEX and intraoperative zonular laxity.