Effect of Capsular Tension Ring Implantation on Postoperative Rotational Stability and Visual Performance of a Multifocal Toric Intraocular Lens

To investigate the effect of capsular tension ring (CTR) implantation on postoperative rotational stability and visual performance of a plate-haptic multifocal toric intraocular lens in highly and non-highly myopic eyes. Consecutive cataract patients intended for phacoemulsification and plate-haptic multifocal toric IOL (AT LISA 909 M) implantation were enrolled and randomized to receive either co-implantation of a CTR or not. Axial length (AL) ≥ 26 mm was defined as highly myopic (HM) eyes. At 3 months postoperatively, IOL rotation degree, residual astigmatism, visual acuity, higher-order aberrations, modulation transfer function, dysfunctional lens index (DLI), and quality of vision index (QVI) were assessed. This prospective cohort study included 44 eyes with CTR implanted and 43 without. In HM eyes, the CTR group showed significantly smaller degree of IOL rotation and less residual astigmatism compared to the non-CTR group, however, no such differences were found in non-HM eyes (both p > 0.05). Furthermore, in HM eyes, despite no difference in visual acuity, the CTR group exhibited significantly lower spherical aberrations and higher DLI and QVI compared to the non-CTR group (all p < 0.05), although no such differences were observed in non-HM eyes (all p > 0.05). Multivariate analysis identified longer AL, larger white-to-white, and non-use of CTR as independent risk factors for greater IOL rotation. The co-implantation of CTR improves the rotational stability of a multifocal toric IOL in HM eyes, hence subsequently enhancing visual quality.