Rotational stability of plate-haptic toric intraocular lenses implantation with a capsular tension ring: a prospective randomized paired-eye study

Purpose: To compare the rotational stability and visual outcomes of plate-haptic toric intraocular lenses (IOLs) with and without a capsular tension ring (CTR) in paired eyes. Setting: Eye and Ears, Nose, and Throat Hospital of Fudan University, Shanghai, China. Design: Prospective, randomized, paired-eye study. Methods: Patients with bilateral cataracts and coexisting regular corneal astigmatism were enrolled. The two eyes of each patient were randomly assigned to the CTR or non-CTR (NCTR) group. Both eyes of each patient were subjected to phacoemulsification and toric IOL implantation. CTRs were implanted into the eyes of the CTR group. All patients were followed-up for 12 months; the uncorrected distance visual acuity (UDVA), residual astigmatism (RAS), and rotational degree of the toric IOL were recorded. Results: In total, 186 eyes of 93 patients were eligible for analysis. At each visit, UDVA improved significantly after surgery in all eyes ( p < 0.001). The mean rotational degree and RAS were significantly smaller in the CTR group at the 2-week visit ( p < 0.05). The toric IOLs achieved rotational stability at 1 week postoperatively in the CTR group while at 2 weeks postoperatively in the NCTR group. In the subgroup analyses, CTR co-implantation significantly reduced the 2-week IOL rotation in eyes meeting specific ocular measurements. Conclusions: CTR co-implantation could increase the rotational stability of plate-haptic toric IOLs, by reducing the amount of the IOL rotation in the early postoperative period and accelerating the stabilization of IOLs in the capsular bag.