Evaluation of the rotational stability of the Toric intraocular lens after cataract capsular tension ring implantation based on the equivalent diameter of the lens measured by CASIA 2

doi:10.11958/20253708

Abstract

Abstract:

Objective To measure the lens equivalent diameter (LE-Dia) using the anterior segment swept-source optical coherence tomography CASIA 2 and investigate its relationship with the rotational stability of toric intraocular lens (IOL) after capsular tension ring (CTR) implantation in highly myopic cataract patients. Methods This prospective randomized controlled study enrolled 40 bilateral highly myopic cataract patients (80 eyes) who visited Hebei Eye Hospital from January 2023 to March 2024. Using a paired design, both eyes of each patient were randomly assigned to the CTR group and the control group, with 40 eyes in each group. Piecewise linear regression was used to determine the threshold of LE-Dia affecting rotational stability. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), the attachment rate of the posterior lens capsule to the posterior surface of the IOL and IOL rotation were compared between the two groups before operation and at 1 week, 1 month, 3 months and 6 months postoperatively. The correlation between LE-Dia and IOL rotation at 6 months postoperatively was also analyzed. Results At 6 months after operation, UCVA and BCVA were significantly improved in both groups compared with preoperative values (all P<0.05). There was no significant difference in the proportion of IOL rotation <5° between the CTR group and the control group (100% vs. 87.5%, P>0.05). The attachment rate of the posterior lens capsule to the posterior surface of the IOL in the CTR group was superior to that in the control group (97.2% vs. 77.8%， P<0.05). The correlation analysis and piecewise regression analysis showed a threshold effect in the correlation between LE-Dia and IOL rotation: when LE-Dia ≤11.0 mm, no significant correlation was observed (r=0.073, P=0.682, β=1.103, R²=0.005); when LE-Dia was 11.1-11.34 mm, a moderate positive correlation was found (r=0.579, P=0.030, β=15.041, R²=0.335); when LE-Dia >11.34 mm, a strong positive correlation was observed (r=0.712, P<0.001, β=8.903, R²=0.507). Conclusion In highly myopic cataractous eyes, LE-Dia is a critical factor affecting toric IOL rotational stability. Conventional CTR is effective when LE-Dia ≤11.0 mm, but has limited efficacy when LE-Dia >11.34 mm, suggesting that individualized capsular support strategies should be selected based on LE-Dia measurements.

Key words: myopia, astigmatism, tomography, optical coherence, multifocal intraocular lenses, rotational stability

CLC Number:

R776.1

Figures/Tables 8

References 21

[1]	Pellegrini M, Furiosi L, Yu A C, et al. Outcomes of cataract surgery with toric intraocular lens implantation after keratoplasty[J]. J Cataract Refract Surg, 2022, 48(2):157-161. doi:10.1097/j.jcrs.0000000000000730.
[2]	刘晓静, 张越, 许衍辉, 等. 不同尺寸囊袋张力环对高度近视合并白内障患者术后囊袋稳定性的影响[J]. 眼科新进展, 2024, 44(10):796-801.
	Liu X J, Zhang Y, Xu Y H, et al. Comparison of the effects of different sizes of capsular tension ring on the stability of capsular bag in patients with high myopia and cataract after surgery[J]. Rec Adv Ophthalmol, 2024, 44(10):796-801. doi:10.13389/j.cnki.rao.2024.0151.
[3]	Kane J X, Chang D F. Intraocular lens power formulas,biometry,and intraoperative aberrometry:A review[J]. Ophthalmology, 2021, 128(11):e94-e114. doi:10.1016/j.ophtha.2020.08.010.
[4]	陈威, 周婧, 杜君, 等. 飞秒激光弧形角膜切开术对白内障合并角膜散光患者的矫正效果[J]. 眼科新进展, 2019, 39(12):1137-1140.
	Chen W, Zhou J, Du J, et al. The effect of femtosecond-assisted arcuate keratotomy on cataract patients with corneal astigmatism[J]. Rec Adv Ophthalmol, 2019, 39(12):1137-1140. doi:10.13389/j.cnki.rao.2019.0261.
[5]	孟克青, 张武林, 董玮, 等. 超声乳化白内障吸出联合CTR植入对高度近视白内障术后囊袋稳定性的影响[J]. 天津医药, 2024, 52(10):1056-1060.
	Meng K Q, Zhang W L, Dong W, et al. Effect of phacoemulsification combined with CTR implantation on capsule stability aftercataract surgery for high myopia[J]. Tianjin Med J, 2024, 52(10):1056-1060. doi:10.11958/20240043.
[6]	Xu S, Zhang Y, Li X, et al. Effect of implanted capsular tension ring on postoperative refractive shift:a systematic review and meta-analysis[J]. Semin Ophthalmol, 2025, 40(3):162-168. doi:10.1080/08820538.2024.2381770.
[7]	Jin A, Han X, Zhang J, et al. Agreement of total keratometry and posterior keratometry among IOL Master 700,CASIA2,and Pentacam[J]. Transl Vis Sci Technol, 2023, 12(3):13. doi:10.1167/tvst.12.3.13.
[8]	Dai C, Liu M, Lv X, et al. Subtle changes of the crystalline lens after cycloplegia:a retrospective study[J]. BMC Ophthalmol, 2021, 21(1):124. doi: 10.1186/s12886-021-01884-9.
[9]	Nagase D, Akura J, Omatsu Y, et al. Intraoperative measurement of crystalline lens diameter in living humans[J]. Yonago Acta Med, 2022, 65(1):53-62. doi:10.33160/yam.2022.02.010.
[10]	Sun Y, Hu Y, Wang C, et al. Effect of capsular tension ring on toric IOL stability and visual outcomes in cataract patients with high myopia:A cohort study including two types of Toric IOL[J]. J Cataract Refract Surg, 2025. doi:10.1097/j.jcrs.0000000000001689. [Epub ahead of print].
[11]	可殊瑞, 李灿. 散光矫正型人工晶状体的旋转稳定性及其影响因素[J]. 国际眼科杂志, 2021, 21(9):1548-1551.
	Ke S R, Li C. Rotational stability of toric intraocular lens and its influencing factors[J]. Int Eye Sci, 2021, 21(9):1548-1551. doi:10.3980/j.issn.1672-5123.2021.9.11.
[12]	Osawa R, Oshika T, Sano M, et al. Rotational stability of modified toric intraocular lens[J]. PLoS One, 2021, 16(3):e0247844. doi:10.1371/journal.pone.0247844.
[13]	Ruhswurm I, Scholz U, Zehetmayer M, et al. Astigmatism correction with a foldable toric intraocular lens in cataract patients[J]. J Cataract Refract Surg, 2000, 26(7):1022-1027. doi:10.1016/s0886-3350(00)00317-5.
[14]	Vokrojová M, HavlíčKová L, BrožKová M, et al. Effect of capsular tension ring implantation on postoperative rotational stability of a toric intraocular lens[J]. J Refract Surg, 2020, 36(3):186-192. doi:10.3928/1081597X-20200120-01.
[15]	Chang D F. Early rotational stability of the longer Staar toric intraocular lens:fifty consecutive cases[J]. J Cataract Refract Surg, 2003, 29(5):935-940. doi:10.1016/s0886-3350(02)01843-6.
[16]	陈紫亮, 饶惠英. Toric人工晶状体术后旋转的影响因素及处理原则[J]. 国际眼科杂志, 2022, 22(10):1662-1665.
	Chen Z L, Rao H Y. Influencing factors of toric intraocular lens postoperative rotation and its principles of treatment[J]. Int Eye Sci, 2022, 22(10):1662-1665. doi:10.3980/j.issn.1672-5123.2022.10.13.
[17]	张旻, 蒋永祥. 把握白内障手术的发展趋势与精准运用人工晶状体各种类型的特点[J]. 中华眼科医学杂志(电子版), 2019, 9(5):257-266.
	Zhang M, Jiang Y X. Grasp the development trend of cataract surgery and the characteristics of precise use of intraocular lenses[J]. Chin J Ophthalmol Med(Electronic Edition), 2019, 9(5):257-266. doi:10.3877/cma.j.issn.2095-2007.2019.05.001.
[18]	曹利群, 王桂琴, 彭秀军, 等. 疏水性和肝素修饰亲水性丙烯酸酯人工晶状体的临床应用效果对比[J]. 眼科新进展, 2012, 32(5):470-472,475.
	Cao L Q, Wang G Q, Peng X J, et al. Comparison between hydrophobic clinical and heparin surface modified hydrophilic acrylic intraocular lenses[J]. Rec Adv Ophthalmol, 2012, 32(5):470-472, 475. doi:10.13389/j.cnki.rao.2012.05.009.
[19]	罗艳, 冯劼, 李培凤, 等. 两种不同设计Toric人工晶状体在高度近视白内障手术中的疗效研究[J]. 华中科技大学学报(医学版), 2023, 52(5):675-680.
	Luo Y, Feng J, Li P F, et al. Efficacy of two different designs of Toric intraocular lens in cataract surgery with high myopia[J]. Acta Med Univ Sci Technol Huazhong, 2023, 52(5):675-680. doi:10.3870/J.issn.1672-0741.23.02.017.
[20]	Zhu X, He W, Zhang K, et al. Factors influencing 1-year rotational stability of AcrySof toric intraocular lenses[J]. Br J Ophthalmol, 2016, 100(2):263-268. doi: 10.1136/bjophthalmol-2015-306656.
[21]	Qi J, Hu X, He W, et al. Effect of capsular tension ring implantation on postoperative rotational stability and visual performance of a multifocal toric intraocular lens[J]. Curr Eye Res, 2025, 50(8):812-819. doi:10.1080/02713683.2025.2495219.

组别	LE-Dia/ mm	眼轴长度/mm	晶状体核硬度分级（Ⅱ/Ⅲ）
对照组	11.17（10.73，11.53）	29.30±1.73	18/22
CTR组	11.18（10.74，11.54）	28.92±2.03	23/17
Z、t或χ²	0.202	0.903	1.251

组别	LE-Dia/ mm	眼轴长度/mm	晶状体核硬度分级（Ⅱ/Ⅲ）
对照组	11.17（10.73，11.53）	29.30±1.73	18/22
CTR组	11.18（10.74，11.54）	28.92±2.03	23/17
Z、t或χ²	0.202	0.903	1.251

组别	术前	术后1周	术后1个月	术后3个月	术后6个月	F
对照组	1.17±0.12	0.40±0.09^a	0.30±0.10^ab	0.31±0.07^ab	0.21±0.09^abcd	474.542^＊＊
CTR组	1.20±0.13	0.41±0.09^a	0.31±0.08^ab	0.28±0.08^ab	0.19±0.08^abcd	598.519^＊＊
t	1.137	0.248	0.251	1.938	0.921
F_组间/F_时间/F_{组间×时间}	0.096/1 072.698^＊＊/1.668

组别	术前	术后1周	术后1个月	术后3个月	术后6个月	F
对照组	1.17±0.12	0.40±0.09^a	0.30±0.10^ab	0.31±0.07^ab	0.21±0.09^abcd	474.542^＊＊
CTR组	1.20±0.13	0.41±0.09^a	0.31±0.08^ab	0.28±0.08^ab	0.19±0.08^abcd	598.519^＊＊
t	1.137	0.248	0.251	1.938	0.921
F_组间/F_时间/F_{组间×时间}	0.096/1 072.698^＊＊/1.668

组别	术前	术后1周	术后1个月	术后3个月	术后6个月	F
对照组	1.04±0.30	0.32±0.20^a	0.31±0.20^a	0.31±0.27^a	0.29±0.20^a	53.634^＊＊
CTR组	1.14±0.27	0.30±0.15^a	0.27±0.13^a	0.29±0.14^a	0.27±0.10^a	84.541^＊＊
t	1.637	0.318	0.978	0.471	0.569
F_组间/F_时间/F_{组间×时间}	0.015/138.293^＊＊/0.932