Eyeworld

22 | EYEWORLD | JULY 2023 ASCRS NEWS Contact Bakshi: shaunak.bakshi@med.usc.edu Bohner: adbohner@gmail.com Christensen: iantchristensen@gmail.com Long: chrisplong7@gmail.com Song: Brian.Song@med.usc.edu Thenappan: aat2164@columbia.edu implantation reduced the time between cataract surgery and ITB dislocation. No clear patho- physiology has been established for this finding; however, the authors proposed selection bias toward a CTR in eyes with zonular weakness and incorrect haptic CTR interaction as possible causes. Overall, this study was robust due to its large sample size and 21-year follow-up period. However, CTR implantation was identified by operative reports and thus may have been underestimated. Also, the authors do not have information as to when the CTR implantation took place intraoperatively. Placing the CTR before phacoemulsification may reduce zonular damage, whereas placing it after could strain the zonular fibers during cortex removal. also found to lower the risk of anterior capsule contraction syndrome, decentration of the entire capsular bag, and PCO. The authors calculated 73 eyes with PEX as the number needed to treat to prevent one late ITB dislocation. In another subgroup analysis, though not statistically significant, CTR implantation in eyes with zonular weakness lowered the risk of ITB dislocation. The lack of statistical signif- icance may be due to the subjective nature of diagnosing zonular weakness and the fact that documenting zonular instability was optional by the authors' protocol, which could have result- ed in underreporting. Based on the results, the authors suggested taking caution in cases with zonular weakness and considering implanting a CTR if deemed appropriate by the surgeon. Consistent with similar prior studies, Mayer-Xanthaki et al. demonstrated CTR continued from page 21 Capsular tension ring as protective measure against in-the-bag dislocations after cataract surgery Mayer-Xanthaki CF, et al. J Cataract Refract Surg. 2023;49:154–158 n Purpose: To assess the influence of capsular tension ring (CTR) implantation on the development of in-the-bag (ITB) dislocations after cataract surgery. n Setting: Department of Ophthalmology Graz, Graz, Austria, Europe. n Design: Single centre, retrospective cohort study. n Methods: The medical records of patients who underwent cataract operation between 1996 and 2017 were analysed. Cox proportional hazards regression analysis was used to assess the influence of CTR implantation and other predisposing factors (pseudoexfoliation [PEX], age, retinitis pigmentosa, gender, zonular weakness, uveitis, high myopia, and intraocular lens design and material) on ITB dislocations. n Results: We found ITB dislocations in 111 (0.16%) out of 68,199 eyes (46,632 patients). In the multivariable analysis adjusted for other predisposing risk factors, a CTR implantation was associated with a lower risk of an ITB dislocation (hazard ratio [HR] 0.29; 95% confidence interval (CI), 0.11–0.80; p=0.017). In eyes with PEX, a CTR implantation was associated with an HR of 0.16 (95% CI, 0.04–0.70; p=0.015), whereas eyes without PEX had an HR of 0.80 (95% CI, 0.14–4.41; p=0.793). A CTR implantation in eyes with zonular weakness resulted in a potentially lower risk (HR 0.37; 95% CI, 0.12–1.12; p=0.078). n Conclusion: According to our data set, implantation of a CTR was a protective measure against an ITB dislocation. Especially in patients with zonular weakness and PEX, the CTR implantation was associated with a lower risk of ITB dislocations. In patients without PEX, no association was established.

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