Capsular tension ring explant complication rate comparison using Miyake-Apple video analysis

Purpose: To compare the complication rate and time required to explant standard capsular tension rings (CTRs) vs suture-guided CTRs (SGCTRs). Setting: Intermountain Ocular Research Center, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah. Design: Experimental study. Methods: Eight cadaver eyes were prepared using standard Miyake-Apple protocol with digital video recording. A 4 clock-hour zonular dialysis was created, followed by a capsulorhexis, hydrodissection, and CTR (n = 4) or SGCTR (n = 4) implantation. With the CTR hidden from view by the overlying iris, ophthalmic surgical instruments were used to remove the CTRs. Time required to remove the CTR and any complications were recorded. A limit of 180 seconds was imposed to determine inability to remove the CTR. Results: In the standard CTR group (n = 4), removal was associated with high rates of complication (100%). Complications included capsular tears (n = 2), dialysis extension (n = 1), and inadvertent intracapsular cataract extraction (n = 1). The SGCTR group had no complications associated with removal (n = 4). Time required to explant a CTR was significantly reduced from 164.5 seconds with standard CTRs to 6.9 seconds with SGCTRs ( P = .001). Conclusions: Attempts to remove a standard CTR from the capsular bag was met with a high complication rate. The addition of suture to the leading eyelet of the CTR prior to implantation significantly reduced the time and effort required to remove the CTR and was associated with a significant reduction in complication rates.