{"title":"Capsular Tension Ring Implantation for Intraocular Lens Position: A Systematic Review and Meta-Analysis.","authors":"Haowen Lin, Yu Zhang, Xiaohang Xie, Xuhua Tan, Ling Jin, Jiaqing Zhang, Lixia Luo, Yizhi Liu","doi":"10.1001/jamaophthalmol.2025.1623","DOIUrl":null,"url":null,"abstract":"<p><strong>Importance: </strong>There is currently no consensus regarding the association of capsular tension ring (CTR) on intraocular lens (IOL) position or the indications for its implantation.</p><p><strong>Objective: </strong>To evaluate the association of CTR implantation on IOL position.</p><p><strong>Data sources: </strong>PubMed, Embase, and Cochrane Library were searched from their inception to October 18, 2024.</p><p><strong>Study selection: </strong>Randomized clinical trials (RCTs) or prospective cohorts reporting the effect or association of CTR on postoperative anterior chamber depth (ACD), IOL decentration, tilt, or rotation.</p><p><strong>Data extraction and synthesis: </strong>Data extraction was conducted by 2 reviewers and verified by another for accuracy. Mean difference (MD) was used to synthesize the effect measures, and subgroup analyses were conducted according to IOL haptic design (C-loop and plate haptic) and whether the patient had high myopia.</p><p><strong>Main outcome and measures: </strong>Postoperative ACD and IOL decentration, tilt, and rotation.</p><p><strong>Results: </strong>A total of 11 RCTs and 7 cohort studies, involving 809 eyes with CTR and 822 eyes without CTR, were included in this meta-analysis. The analysis revealed that IOL tilt (MD, -1.04°; 95% CI, -2.05° to -0.03°; P = .04) and rotation (MD, -0.82°; 95% CI, -1.27° to -0.37°; P < .001) were smaller in the CTR group compared with the control group. The subgroup analysis of ACD (I2 = 70.7%; P = .03), decentration (I2 = 66.5%, P = .08), and tilt (I2 = 76.7%, P = .01) revealed a heterogeneity between the subgroups stratified according to IOL haptic design. Additionally, subgroup analysis demonstrated that CTR group showed a deeper ACD in eyes implanted with plate haptic IOLs (MD, 0.11 mm; 95% CI, 0.02 to 0.20 mm; P = .01), and a smaller IOL tilt in highly myopic eyes (MD, -1.43°; 95% CI, -2.59° to -0.26°; P = .02) compared with the control group.</p><p><strong>Conclusions and relevance: </strong>CTR implantation was associated with enhanced stability of IOL rotation in this meta-analysis, while only reducing IOL tilt in high myopia. While the direct clinical relevance of these results could not be determined from this investigation, these findings provide evidence supporting use of CTR implantation when toric IOLs have been implanted or with high myopia, although a hyperopic refractive shift after implantation of plate haptic IOLs may require target refraction adjustment.</p>","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":""},"PeriodicalIF":7.8000,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12163718/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JAMA ophthalmology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1001/jamaophthalmol.2025.1623","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Importance: There is currently no consensus regarding the association of capsular tension ring (CTR) on intraocular lens (IOL) position or the indications for its implantation.
Objective: To evaluate the association of CTR implantation on IOL position.
Data sources: PubMed, Embase, and Cochrane Library were searched from their inception to October 18, 2024.
Study selection: Randomized clinical trials (RCTs) or prospective cohorts reporting the effect or association of CTR on postoperative anterior chamber depth (ACD), IOL decentration, tilt, or rotation.
Data extraction and synthesis: Data extraction was conducted by 2 reviewers and verified by another for accuracy. Mean difference (MD) was used to synthesize the effect measures, and subgroup analyses were conducted according to IOL haptic design (C-loop and plate haptic) and whether the patient had high myopia.
Main outcome and measures: Postoperative ACD and IOL decentration, tilt, and rotation.
Results: A total of 11 RCTs and 7 cohort studies, involving 809 eyes with CTR and 822 eyes without CTR, were included in this meta-analysis. The analysis revealed that IOL tilt (MD, -1.04°; 95% CI, -2.05° to -0.03°; P = .04) and rotation (MD, -0.82°; 95% CI, -1.27° to -0.37°; P < .001) were smaller in the CTR group compared with the control group. The subgroup analysis of ACD (I2 = 70.7%; P = .03), decentration (I2 = 66.5%, P = .08), and tilt (I2 = 76.7%, P = .01) revealed a heterogeneity between the subgroups stratified according to IOL haptic design. Additionally, subgroup analysis demonstrated that CTR group showed a deeper ACD in eyes implanted with plate haptic IOLs (MD, 0.11 mm; 95% CI, 0.02 to 0.20 mm; P = .01), and a smaller IOL tilt in highly myopic eyes (MD, -1.43°; 95% CI, -2.59° to -0.26°; P = .02) compared with the control group.
Conclusions and relevance: CTR implantation was associated with enhanced stability of IOL rotation in this meta-analysis, while only reducing IOL tilt in high myopia. While the direct clinical relevance of these results could not be determined from this investigation, these findings provide evidence supporting use of CTR implantation when toric IOLs have been implanted or with high myopia, although a hyperopic refractive shift after implantation of plate haptic IOLs may require target refraction adjustment.
期刊介绍:
JAMA Ophthalmology, with a rich history of continuous publication since 1869, stands as a distinguished international, peer-reviewed journal dedicated to ophthalmology and visual science. In 2019, the journal proudly commemorated 150 years of uninterrupted service to the field. As a member of the esteemed JAMA Network, a consortium renowned for its peer-reviewed general medical and specialty publications, JAMA Ophthalmology upholds the highest standards of excellence in disseminating cutting-edge research and insights. Join us in celebrating our legacy and advancing the frontiers of ophthalmology and visual science.