Potential risk of capsular tension ring implantation combined with phacoemulsification in high myopia patients by increasing central macular thickness and intraocular lens tilt: a retrospective comparative study with 1-week, 1-month, and 3-month outcomes
Abstract
This study investigated the effects of phacoemulsification combined with capsular tension ring (CTR) implantation on the central macular thickness (CMT) and intraocular lens (IOL) tilt in highly myopic eyes with cataract at 3 months postoperatively. A retrospective study analyzed 169 highly myopic eyes from 91 cataract patients, divided into two groups: the CTR group (47 patients, 86 eyes) underwent phacoemulsification with CTR implantation, and the control group (44 patients, 83 eyes) underwent phacoemulsification alone. Patients were further stratified by axial length (AL) into two subgroups: 26 mm ≤ AL <30 mm and AL ≥ 30 mm. Postoperative outcomes, including refractive prediction error (RPE), CMT changes, IOL tilt, and decentration, were assessed at 1 week, 1 month, and 3 months. Visual acuity was quantified using logarithm of the minimum angle of resolution (LogMAR). In accordance with the principle that a higher LogMAR value indicates poorer vision, best-corrected visual acuity (BCVA) improved significantly in both groups compared with preoperative levels at 1 week (0.14 ± 0.23 vs. 0.29 ± 0.44), 1 month (0.14 ± 0.30 vs. 0.25 ± 0.38), and 3 months (0.11 ± 0.21 vs. 0.24 ± 0.39) postoperatively (p < 0.05). Notably, BCVA in the subgroup with AL of 26 mm ≤ AL <30 mm was significantly better than that in the subgroup with AL ≥ 30 mm (p < 0.05). Additionally, no significant difference in RPE was observed between the two groups at any of the three time points (all p > 0.05). However, although IOL position (tilt and decentration) did not differ significantly between groups at 1 or 3 months overall, the CTR subgroup with 26 mm ≤ AL <30 mm exhibited greater IOL tilt (5.275 ± 3.708°) than the control subgroup (3.846 ± 2.262°) at 3 months (p = 0.021). Similarly, while no overall intergroup difference in CMT was detected across time points, the CTR subgroup with 26 mm ≤ AL <30 mm showed a significantly greater mean CMT change (8.831 ± 27.656 μm) compared with the control subgroup (−4.270 ± 32.486 μm) at 1 week (p = 0.046). CTR implantation during phacoemulsification poses a potential risk in high myopia patients, particularly those with axial lengths between 26 mm and 30 mm, by increasing both CMT and IOL tilt.