Rotation of a toric intraocular lens with and without capsular tension ring: data from a multicenter non-inferiority randomized clinical trial (RCT)

BMC Ophthalmol. 2019 Jul 8;19(1):143. doi: 10.1186/s12886-019-1147-5.


Background: Evaluation of clinical outcome in cohorts with versus without simultaneous implantation of a capsular tension ring (CTR) and a toric lens (Tecnis Toric). Main parameter was rotation referring - in contrast to misalignment - to the IOL axis change from immediately after implantation to the final postoperative position.

Methods: Lens position was measured at baseline with the patient still in recumbent position, postoperative rotation was calculated by software. Postoperative evaluation included measurement three months after surgery or prior to an indicated revision surgery. Explorative re-evaluation of the underlying RCT's intent-to-treat population was performed for the entire sample and stratified for cohorts by 95% confidence intervals for binary endpoints' incidences (primary endpoint: absolute postoperative rotation ≤5 degrees; secondary endpoints: absolute deviation between achieved cylinder and target cylinder ≤0.5 dpt, postoperative corrected distance visual acuity (CDVA) ≥ 0.8). Data exploration was based on medians and quartiles.

Setting: Outpatient study sites.

Design: Re-evaluation based on data from a multicenter non-inferiority randomized clinical trial (RCT).

Results: Sub cohorts (without CTR 89, with CTR 90 patients) did not present clinically relevant differences in preoperative characteristics: revision surgery was performed in 7 cases (3 without and 4 with CTR). Primary endpoint incidences for the total sample, without and with CTR were 90%/89%/90%; cylinder endpoint incidences were 46%/45%/46% and CDVA endpoint incidences 90%/92%/88%. Median absolute rotations were 1.74°/1.79°/1.72°, median absolute cylinder deviations 0.55/0.52/0.55 dpt and median visual acuity 1.0/1.0/1.0.

Conclusion: No clinically relevant differences between CTR subgroups were found; a satisfying three months rotational stability was achieved.

Trial registration: The trial was registered retrospectively in the trial registry DRKS, trial registration number DRKS00015316 , date of registration 27. August 2018.

Keywords: Capsular tension ring; Misalignment; Rotation; Toric intraocular lens.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Artificial Lens Implant Migration / physiopathology
  • Artificial Lens Implant Migration / prevention & control
  • Female
  • Follow-Up Studies
  • Humans
  • Lens Capsule, Crystalline / surgery*
  • Lenses, Intraocular*
  • Male
  • Middle Aged
  • Phacoemulsification
  • Prospective Studies
  • Prosthesis Design
  • Pseudophakia / physiopathology
  • Pseudophakia / surgery*
  • Refraction, Ocular / physiology*
  • Time Factors
  • Visual Acuity*