Effect of capsular tension ring on toric intraocular lens stability and visual outcomes in cataract patients with high myopia: cohort study including two types of toric intraocular lenses

Purpose: To evaluate capsular tension ring (CTR) impact on toric intraocular lens (IOL) stability in high axial myopia (axial length [AL] ≥26 mm). Setting: 10th People's Hospital Affiliated to Tongji University, Shanghai, China. Design: Ambispective cohort study. Methods: 90 eyes (68 patients) received CTR with toric IOL (CTR group, n = 55) or toric IOL alone (control, n = 35). Outcomes included rotational stability, decentration, tilt, residual astigmatism, and visual acuity at 1 week and 3 months. Statistical analyses incorporated t tests, Kaplan-Meier survival analysis, and generalized estimating equations. Results: CTR improved early rotational stability (3.20 ± 5.23 degrees vs 4.26 ± 3.68 degrees, P = .03) and reduced ≥10 degrees rotation incidence (1.8% vs 12.9%, P = .04). At 3 months, CTR decreased decentration (0.28 ± 0.14 mm vs 0.43 ± 0.37 mm, P = .04) without affecting tilt. In the AL ≥30 mm subgroup, CTR reduced residual astigmatism (1 week: P = .04) and delayed ≥10 degrees rotation onset ( P = .003). Plate-haptic IOLs had higher rotation risk than C-loop designs (relative risk [RR] = 6.613, P = .01), but CTR reduced tilt in the plate-haptic subgroup (0.96 degrees vs 2.03 degrees, P = .005). Advanced age independently lowered rotation risk (RR = 0.89, P = .004). Conclusions: CTR enhances rotational stability and reduces decentration in high myopia, particularly for AL ≥30 mm eyes. C-loop IOLs outperform plate-haptic designs in rotation resistance. Age is a protective factor against rotation. These findings support CTR use with plate-haptic IOLs in elongated eyes to optimize outcomes.