Long-term outcomes of capsular tension ring implantation during phacoemulsification with intraocular lens implantation combined with trabeculectomy in acute angle-closure crisis

Abstract

To evaluate the 3-year efficacy and safety of capsular tension ring (CTR) implantation during phacoemulsification with intraocular lens implantation (PEI) combined with trabeculectomy (Trab) in patients with acute angle-closure crisis (AACC). Retrospective cohort study. Patients who underwent PEI+Trab were divided into two groups according to whether they received concurrent CTR implantation. Postoperative clinical indicators were collected at 1, 3, 12, 24, and 36 months and compared between the CTR and non-CTR groups. Uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (BCDVA), refractive prediction error (PE), intraocular lens (IOL) tilt, intraocular pressure (IOP), anterior chamber depth (ACD), corneal endothelial cell density (ECD), and complication rates. Among 114 eyes of 114 patients with AACC, 54 received CTR implantation and 60 did not. Three-year follow-up was completed in 68.4% of patients. At 3 years, UDVA was significantly better in the CTR group than in the non-CTR group (median [IQR] 0.22 [0.10–0.30] vs. 0.30 [0.22–0.60]; P = 0.02) and remained stable throughout follow-up. In contrast, UDVA in the non-CTR group fluctuated markedly and did not stabilize until 2 years after surgery. BCDVA was comparable between groups (median [IQR] 0.10 [0.00–0.16] vs. 0.10 [0.00–0.26]; P = 0.41). PE was consistently lower in the CTR group (0.32 ± 0.73 D vs. 0.77 ± 0.88 D; P = 0.03), and IOL tilt was also significantly reduced (median [IQR] 0.16° [0.12–0.29] vs. 0.42° [0.31–0.61]; P < 0.001). ACD and ECD did not differ significantly between groups (ACD: 3.55 ± 2.86 mm vs. 3.54 ± 2.59 mm, P = 0.85; ECD: 1410.05 ± 470.19 vs. 1558.98 ± 405.97 cells/mm², P = 0.14). IOP remained similar between groups at all time points over the 3-year follow-up (all P > 0.05). The CTR group showed a significantly lower incidence of CCS (0% vs. 20.6%; P = 0.01). However, rates of IOL pupil capture (19.4% vs. 2.9%; P = 0.03) and YAG laser capsulotomy for PCO (40.7% vs. 23.3%; P = 0.046) were higher in the CTR group. One patient in each group required reoperation. The proportion of patients requiring long-term antiglaucoma medications did not differ significantly between groups (9.7% vs. 2.9%; P = 0.26). In AACC patients undergoing PEI+Trab, CTR implantation reduces IOL tilt and PE, improves long-term refractive stability, thereby optimizing long-term UDVA, and lowers CCS risk without compromising IOP control or ACD stability. However, the higher incidences of IOL capture and YAG laser capsulotomy for PCO in the CTR group warrant further clinical investigation.