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Risk factors and outcomes of capsular tension ring insertion during cataract surgery in an Australian teaching hospita

Risk factors and outcomes of capsular tension ring insertion during cataract surgery in an Australian teaching hospital. s. E. Chan, B. Wang, R. Vajpayee Royal Victorian Eye and Ear Hospital Melbourne. Financial Disclosures: nil. Background.

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Risk factors and outcomes of capsular tension ring insertion during cataract surgery in an Australian teaching hospita

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  1. Risk factors and outcomes of capsular tension ring insertion during cataract surgery in an Australian teaching hospital s E. Chan, B. Wang, R. Vajpayee Royal Victorian Eye and Ear Hospital Melbourne Financial Disclosures: nil

  2. Background • Capsular tension rings (CTRs) are designed to support the lens capsule in cases where zonular weakness or loss is present1 • CTRs are becoming more common in cataract surgery • However, there is a paucity of data profiling patients requiring CTRs and the outcomes of these patients • At the Royal Victorian Eye and Ear Hospital, Melbourne, Australia, over 6000 cataract operations are performed each year, providing a large database of patients from which to conduct this study 1Menapace et al. JCRS 2000; 26: 898

  3. Objective • To determine the • pre-operative risk factors • intra-operative procedures • complications and • visual outcomes • of patients requiring CTRs during cataract surgery over the past 10 years at a major Australian teaching hospital

  4. Methods • Design - retrospective medical record review • Methods • Cases identified through medical record coding • Inclusion criteria: • Surgery from 1st July, 2000 to 30th June, 2010 • Patients coded for ‘cataract extraction’ and ‘capsular tension ring’ • Patients done under the public ‘Medicare’ system • Exclusion criteria: • Incorrect coding • Medical notes unable to be located (4 cases) • Surgery where cataract extraction was not the primary reason for surgery (eg. vitrectomy for vitreous haemorrhage) • Data analysis - SPSS

  5. Results – pre-op • 84 eyes of 82 patients had insertion of CTR, and were analyzed for this study • Demographics • Average age = 66.2 years (range 10 – 90 years) • Sex = 58% female, 42% male • Pre-operative visual acuity • Mean 20/60 • Operating surgeon • 44 trainee • 40 senior surgeon

  6. Results – pre-op Risk factors for CTR insertion identified pre-operatively *in absence of PXF or known history of trauma note: 11 patients had 2 risk factors

  7. Results – intra-op Procedures performed

  8. Results – intra-op • CTR type • A range of commercially available types of CTRs used • Incomplete data on method of insertion (manual vs injected) • No sutured CTRs used

  9. Results – post-op Post-operative complications

  10. Results – post-op Secondary post-operative procedures note: Some patients had more than 1 procedure

  11. Results – post-op • At 3 months: • Mean VA 20/30 • 67 (80%) eyes achieved 20/40 or better in absence of ocular co-morbidities

  12. Summary and conclusion • 75% of cases of CTR insertion occurred in patients with known risk factors (trauma, mature cataract, PXF) • 33% of cases were associated with an unplanned procedure (anterior vitrectomy or conversion to ECCE) • Most cases (86%) had a PCIOL inserted successfully • Post-operative complications included IOL decentration, corneal edema and raised IOP with 6% of cases requiring a return to theatre for a second procedure • CTRs had a YAG capsulotomy rate of 10.7% • 92.9% of cases had an improvement in visual acuity 3 months post-operatively • Conclusion • The use of CTRs in complex cataract surgeries are associated with successful outcomes in the majority of cases

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