Influence of a Capsular Tension Ring on Capsular Bag Behavior of a Plate Haptic Intraocular Lens: An Intraindividual Randomized Trial

PURPOSE

To evaluate the influence of a capsular tension ring (CTR) on rotational stability, decentration, tilt, and axial stability of an 11.0-mm plate haptic intraocular lens (IOL).

DESIGN

Intraindividual, randomized, double-masked, controlled clinical trial.

PARTICIPANTS

Patients scheduled for sequential same-day bilateral cataract surgery.

METHODS

All patients were randomized to receive a CTR and a plate haptic IOL in one eye and a plate haptic IOL in the fellow eye only. Intraocular lens axis assessment was performed at the end of surgery, 1 hour, 1 week, 1 month, and 6 months using a high-precision evaluation method. Decentration and tilt of the crystalline and pseudophakic lenses were assessed before surgery and at 1 week and 6 months using an anterior segment OCT.

MAIN OUTCOME MEASURES

Rotational stability from the end of surgery to 6 months and at all follow-up visits, decentration and tilt at 6 months, and differences in axial shift between 1 week and 6 months.

RESULTS

One hundred thirty eyes of 65 patients were included in the study. Absolute rotation from the end of surgery to 6 months was 2.8 ± 3.9° and 3.2 ± 5.3° for the CTR and control groups, respectively (P = 0.613). Intraocular lens decentration and IOL tilt at 6 months were 0.29 ± 0.1 mm and 0.24 ± 0.1 mm and 6.7 ± 2.8° and 5.6 ± 1.6° for the CTR and control groups, respectively (P = 0.058; P < 0.01). A posterior IOL shift of 0.31 ± 0.31 mm and 0.19 ± 0.14 mm was observed in the CTR and control groups, respectively.

CONCLUSIONS

Concomitant implantation of a CTR and a plate haptic IOL did not improve the overall rotational stability of the IOL compared with the control group. Against expectations, higher values of decentration, tilt, and axial shift were observed in the CTR group. The simultaneous use of a CTR and a plate haptic IOL in the absence of zonular weakness at the time of cataract surgery should be considered with caution.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Patients with Intermittent Exotropia and Exophoria Exhibit Non-aggravated Lens Decentration After Orthokeratology Application: The Nanjing Strabismus Cohort

INTRODUCTION

There is a high prevalence of intermittent exotropia and exophoria in myopic populations, and orthokeratology is one of the effective interventions to control myopia progression in children. However, it is still obscure whether intermittent exotropia and exophoria children could wear orthokeratology without experiencing aggravated lens decentration.

METHODS

This was a multi-center, prospective cohort study. A total of 123 myopic participants aged 8-14 years were recruited, where conditions of deviation included intermittent exotropia, exophoria, and orthophoria. Uncorrected visual acuity and corneal topography data were obtained at baseline and after 1 month of wearing orthokeratology lens. Lens decentration was analyzed in a MATLAB program. Magnitude of deviation and refractive errors were evaluated prior to orthokeratology treatment. Fisher's exact test, ANOVA test, and univariate and multivariate linear regression models were established to evaluate the role of magnitude of deviation in lens decentration.

RESULTS

There was no significant difference in magnitude and direction of lens decentration among three groups (magnitude: F = 1.25, P = 0.289; direction: Fisher = 9.91, P = 0.078). According to scale division of decentration, 1 (2.6%) intermittent exotropia subject, 2 (3.8%) exophoria subjects, and 1 (3.0%) orthophoria subject experienced severe decentration (Fisher = 1.10, P = 0.947). Inferotemporal decentration was most common among all subjects (intermittent exotropia 50.0%, exophoria 76.9%, orthophoria 72.7%). Univariate and multivariate linear regression analyses revealed that magnitude of deviation was not an independent risk factor for lens decentration [β = -0.00, 95% confidence interval (CI) -0.01-0.00, P = 0.180], while surface asymmetry index (SAI) (β = 0.21, 95% CI 0.02-0.40, P = 0.028) and surface regularity index (SRI) (β = -0.39, 95% CI -0.66 to -0.13, P = 0.004) had significant correlation with polar decentration.

CONCLUSION

Patients with intermittent exotropia and exophoria exhibit non-aggravated lens decentration after orthokeratology application. Thus, lens decentration is not the concern for orthokeratology prescription.