1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. Results – post-op
Post-operative complications

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

11. 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

12. 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