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

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Abstract

Purpose

To assess the contribution of capsular tension ring (CTR) to postoperative stability and visual outcomes of a plate-haptic toric intraocular lens (IOL).

Methods

This prospective cohort study was performed among patients underwent toric IOL (AT TORBI 709 M) 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.

Results

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).

Conclusion

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) ≥ 4.5 mm, white-to-white (WTW) ≥ 11.6 mm, or high preexisting astigmatism.

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Data availability

Data are available on reasonable request from the corresponding author.

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Funding

This work was funded by the National Natural Science Foundation of China (Grant No. 82171039) and the Xinjiang Production and Construction Corps Financial Technology Plan Project (Grant No. 2020CB030).

Author information

Author notes

  1. Dongmei Ma and Xiaoyan Han contributed equally to the paper and should be considered as joint first author.

Authors and Affiliations

  1. Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, 83 Fenyang Rd., Xuhui District, Shanghai, China

    Dongmei Ma, Xiaoyan Han, Zhixiang Hua, Tian Qiu, Lei Cai & Jin Yang

  2. NHC Key Laboratory of Myopia, Fudan University; Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China

    Dongmei Ma, Xiaoyan Han, Zhixiang Hua, Tian Qiu, Lei Cai & Jin Yang

  3. Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China

    Dongmei Ma, Xiaoyan Han, Zhixiang Hua, Tian Qiu, Lei Cai & Jin Yang

  4. Department of Ophthalmology, Shanghai Heping Eye Hospital, Shanghai, China

    Jiying Shen & Limei Zhang

  5. Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China

    Jianfeng Luo

  6. NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China

    Jianfeng Luo

  7. Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China

    Jianfeng Luo

Authors
  1. Dongmei Ma
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  9. Jin Yang
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Contributions

All authors contributed to the study design and data collection; Jianfeng Luo, Dongmei Ma, and Zhixiang Hua analyzed the data and created the figures and tables; Xiaoyan Han and Dongmei Ma drafted the manuscript; Jin Yang modified the manuscript.

Corresponding author

Correspondence to Jin Yang.

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Ethics approval and consent to participate

The study was performed in accordance with the tenets of the Declaration of Helsinki and was approved by the Institutional Review Board of the Eye and ENT hospital. Written informed consent was obtained from all patients.

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Not applicable.

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The authors declare no competing interests.

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Ma, D., Han, X., Hua, Z. et al. Propensity-matched comparison of postoperative stability and visual outcomes of toric intraocular lens with or without a capsular tension ring and updated meta-analysis. Graefes Arch Clin Exp Ophthalmol 261, 989–998 (2023). https://doi.org/10.1007/s00417-022-05851-y

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