Propensity-matched comparison of postoperative stability and visual outcomes of toric intraocular lens with or without a capsular tension ring and updated meta-analysis.

Abstract

To assess the contribution of capsular tension ring (CTR) to postoperative stability and visual outcomes of a plate-haptic toric intraocular lens (IOL). This prospective cohort study was performed among patients underwent toric IOL (AT TORBI 709M) implantation with or without CTR at the Eye and ENT hospital between April 2020 and November 2021. Propensity score matching (PSM) was performed to balance baseline factors. Postoperatively, uncorrected distance visual acuity (UCVA) and residual astigmatism, as well as IOLs' rotation, tilt, and decentration, were analyzed. Grouped multiple linear regression analysis was used to model predictive factors of rotation in each group. Additionally, a meta-analysis of data from 4 publications (284 eyes) and current study was performed to evaluate the effect of CTR co-implantation on toric IOL rotation. After PSM, 126 eyes from each group were included for further analysis. Postoperatively, UDVA was 0.31 ± 0.38 logMAR and 0.27 ± 0.36 logMAR in the CTR and NCTR groups, respectively (P = 0.441), and residual astigmatism was 0.75 ± 0.52 D and 0.86 ± 0.65 D, respectively (P = 0.139). The rotation of toric IOL was significantly smaller in the CTR group than in the NCTR group (4.63 ± 6.27 vs. 10.93 ± 16.05 degrees, P < 0.001). The regression models of the two groups and the coefficients of LT were significantly different (P < 0.001 and P = 0.001, respectively). Furthermore, the meta-analysis confirmed that CTR co-implantation reduced toric IOL rotation (MD, - 1.59; 95% CI, - 3.10 to - 0.09; P = 0.038). CTR enhances rotational stability of toric IOL by reducing the impact of LT, and CTR co-implantation is recommended in patients with lens thickness (LT) ≥ 4.5mm, white-to-white (WTW) ≥ 11.6mm, or high preexisting astigmatism.