Optimal timing of capsular tension ring implantation in pseudoexfoliation syndrome

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.

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.

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.

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.