Optimal timing of capsular tension ring implantation in pseudoexfoliation syndrome

ABSTRACT Purpose: The aim of this study was to evaluate the appropriate timing of capsular tension ring implantation in cases of zonular weakness due to pseudoexfoliation syndrome. Methods: This prospective, comparative study was performed at the Ophthalmology Department of Inonu University, Malatya, Turkey. There were 43 patients included in the study. Group 1 (16 patients) had early capsular tension ring implantation, and group 2 (27 patients) had late capsular tension ring implantation. Patients with pseudoexfoliation syndrome who underwent phacoemulsification surgery, posterior chamber intraocular lens implantation, and capsular tension ring implantation were included in the study. Intraoperative complications and difficulties with either capsular tension ring implantation or cortex removal were evaluated in each eye. Results: There was no significant difference between the groups in the difficulty of capsular tension ring implantation (p=0.124). The difficulty of cortex removal differed significantly between the groups (p=0.003). Intraoperative complications were observed in 3 patients in group 1 and 11 patients in group 2; the difference between the groups was not significant (p=0.18). Posterior capsule fluctuations were observed in 8 patients (29.5%) in group 2, which resulted in posterior capsule rupture in 2 patients. Conclusions: Cortex removal is more difficult with early capsular tension ring implantation, and posterior capsule fluctuations may cause problems with late capsular tension ring implantation. The surgeon must consider the risk-to-benefit ratio of early versus late insertion for the optimal timing of capsular tension ring implantation.摘要 目的：本研究旨在评估假性剥脱综合征（pseudoexfoliation syndrome）所致悬韧带松弛患者囊袋张力环（capsular tension ring）植入的适宜时机。 方法：本前瞻性对照研究于土耳其马拉蒂亚因诺努大学眼科开展，共纳入43例患者。其中1组（16例）接受早期囊袋张力环植入，2组（27例）接受晚期囊袋张力环植入。本研究纳入接受超声乳化白内障吸除术（phacoemulsification surgery）、后房型人工晶状体（posterior chamber intraocular lens）植入联合囊袋张力环植入的假性剥脱综合征患者。对每例术眼的术中并发症、囊袋张力环植入难度及皮质去除难度进行评估。 结果：两组囊袋张力环植入难度无显著差异（p=0.124）。两组皮质去除难度差异具有统计学意义（p=0.003）。1组有3例患者出现术中并发症，2组有11例，组间差异无统计学意义（p=0.18）。2组有8例患者（29.5%）出现后囊膜震颤，其中2例继发后囊膜破裂。 结论：早期囊袋张力环植入会增加皮质去除难度，而晚期囊袋张力环植入可能因后囊膜震颤引发相关问题。术者需权衡早期与晚期植入的风险获益比，以确定囊袋张力环植入的最佳时机。