Royal Victorian Eye and Ear Hospital Risk factors and outcomes of capsular tension ring insertion during cataract surgery in an Australian teaching hospital s E. Chan, B. Wang, R. Vajpayee Royal Victorian Eye and Ear Hospital Melbourne Financial Disclosures: nil

Background   Capsular tension rings (CTRs) are designed to support the lens capsule in cases where zonular weakness or loss is present1 CTRs are becoming more common in cataract surgery However, there is a paucity of data profiling patients requiring CTRs and the outcomes of these patients At the Royal Victorian Eye and Ear Hospital, Melbourne, Australia, over 6000 cataract operations are performed each year, providing a large database of patients from which to conduct this study 1Menapace et al. JCRS 2000; 26: 898

Objective To determine the pre-operative risk factors intra-operative procedures complications and visual outcomes of patients requiring CTRs during cataract surgery over the past 10 years at a major Australian teaching hospital

Methods Design - retrospective medical record review Methods Cases identified through medical record coding Inclusion criteria: Surgery from 1st July, 2000 to 30th June, 2010 Patients coded for ‘cataract extraction’ and ‘capsular tension ring’ Patients done under the public ‘Medicare’ system Exclusion criteria: Incorrect coding Medical notes unable to be located (4 cases) Surgery where cataract extraction was not the primary reason for surgery (eg. vitrectomy for vitreous haemorrhage) Data analysis - SPSS  

Results – pre-op   84 eyes of 82 patients had insertion of CTR, and were analyzed for this study Demographics Average age = 66.2 years (range 10 – 90 years) Sex = 58% female, 42% male Pre-operative visual acuity Mean 20/60 Operating surgeon 44 trainee 40 senior surgeon

Results – pre-op Risk factors for CTR insertion identified pre-operatively   *in absence of PXF or known history of trauma note: 11 patients had 2 risk factors

Results – intra-op Procedures performed PROCEDURE %   Procedures performed PROCEDURE % Phacoemulsification only 73% Anterior vitrectomy (unplanned) 25% Conversion to ECCE (unplanned) 8.3% Iridoplasty (planned) 3.6% Insertion of iris prosthesis (planned) 1.1% Bleb needling

Results – intra-op CTR type A range of commercially available types of CTRs used Incomplete data on method of insertion (manual vs injected) No sutured CTRs used  

Results – post-op Post-operative complications

Results – post-op Secondary post-operative procedures note: Some patients had more than 1 procedure

Results – post-op At 3 months: Mean VA 20/30   At 3 months: Mean VA 20/30 67 (80%) eyes achieved 20/40 or better in absence of ocular co-morbidities

Summary and conclusion 75% of cases of CTR insertion occurred in patients with known risk factors (trauma, mature cataract, PXF) 33% of cases were associated with an unplanned procedure (anterior vitrectomy or conversion to ECCE) Most cases (86%) had a PCIOL inserted successfully Post-operative complications included IOL decentration, corneal edema and raised IOP with 6% of cases requiring a return to theatre for a second procedure CTRs had a YAG capsulotomy rate of 10.7% 92.9% of cases had an improvement in visual acuity 3 months post-operatively Conclusion The use of CTRs in complex cataract surgeries are associated with successful outcomes in the majority of cases