Clinical Observation Of Visual Quality After High-myopia Cataract Surgery With Capsular Tension Ring

Objective:To observe the effect of capsular tension ring(CTR)implantation on refractive accuracy and the visual quality of high myopia patients with cataract.Methods:From November 2016 to April 2018,28 patients(40 eyes)with high myopia and cataract who were treated at the Department of Ophthalmology of the Second Affiliated Hospital of Kunming Medical University were selected.In experimental group A1(20 eyes):CTR + Aqua Sense PAL intraocular lens(IOL)was implanted,and in control group A2(20 eyes):Ai Rui aspherical IOL was implanted.At the same time,17 cases(22 eyes)of high myopia cataract patients were in the experimental group B1 group(8 eyes):CTR+Bigbag IOL was implanted,and in the control group B2 group(13 eyes):Bigbag IOL was implanted.3 months after the operation,uncorrected visual acuity(UCVA)and best corrected visual acuity(BCVA)were recorded;postoperative refractive error was calculated(postoperative refraction and preoperative preserving power difference The absolute value);OPD-Scan III refractive power/cornea analyzer was used to examine the intraocular high-order aberration(HOA),intraocular comatic aberration(Coma),intraocular lens Intraocular lens tilt Tilt and MTF cut off at 3 mm and 5 mm pupil diameters;posterior capsular folds and posterior capsular opacification(PCO)were observed under a slit lamp microscope.Results:(1)Preoperative A1 and A2(Aqua Sense PAL)groups had no statistically significant differences in age,corneal curvature,and axial length(AL)(P>0.05).(2)Preoperative B1 and B2(Bigbag)groups had no statistically significant differences in age,corneal curvature,and axial length(P>0.05).(3)There was no significant difference in postoperative visual acuity(UCVA)and best corrected visual acuity(BCVA)between A1 and A2(Aqua Sense PAL)patients(all P>0.05).(4)There was no significant difference in postoperative visual acuity(UCVA)and best corrected visual acuity(BCVA)between B1 and B2 patients(P>0.05).(5)There was no postoperative hyperopic refractive error in both groups A1 and A2.There was no significant difference in the number of IOLs and the expected refractive power between the two groups(P>0.05).The refractive error value of the two groups after surgery in the A1 group<A2 group,the difference was statistically significant(P=0.022,P<0.05).(6)There was no postoperative hyperopic refractive error in patients with B1 and B2(Bigbag).There was no significant difference in the degree of implantation of IOL,expected refractive power,and postoperative refractive error between the two groups(P>0.05).(7)Under 3 mm and 5 mm pupil diameters:There were no significant differences in intraocular high-order aberration HOA,intraocular coma aberration Coma,IOL tilt Tilt,and A1 and A2(Aqua Sense PAL)(P>0.05).The cut-off frequency of MTF in the two groups with pupil diameter of 3 mm was significantly higher in the A1 group than in the A2 group(P=0.005,P<0.05).The cut-off frequency of MTF in the two groups was greater than the A1 group and A2 group at 5 mm pupil diameter(P=0.011,P<0.05).(6)There was no postoperative hyperopic refractivity in both groups B1 and B2.There was no significant difference in the IOL degree,expected refractive power,and postoperative refractive error between the two groups(P>0.05).(7)Under 3 mm and 5 mm pupil diameters,there were no significant differences in intraocular high-order aberrations(HOA),intraocular coma(Coma),and IOL tilt(Tilt)between groups A1 and A2(P>0.05).The MTF cut-off frequency in the two groups of pupil diameters of 3 mm and 5 mm was higher in A1 group than in A2 group(P<0.05).(8)Under 3 mm and 5 mm pupil diameters,there were no significant differences in intraocular high-order aberration HO A,intraocular coma aberration,Coma,IOL tilt Tilt,and MTF cut-off frequency between groups B1 and B2(P>0.05).(9)In the A1 group(20 eyes),there was no obvious posterior capsular opacification;in the A2 group(20 eyes),the posterior capsular membrane was slightly cloudy with an incidence of 10%.There was no significant difference in the occurrence of posterior capsular opacification between A1 and A2 groups(P=0.487,P>0.05).(10)There was no posterior capsule fold in group A1(20 eyes);posterior capsular fold occurred in 12 eyes of group A2(20 eyes),and the incidence was 60%.There was a statistically significant difference in the occurrence of posterior capsule folds between the A1 and A2 groups(P<0.001).(11)There was no obvious posterior capsular opacification in group B1(8 eyes)and group B2(13 eyes).(12)Posterior capsular folds did not appear in the B1 group(8 eyes)and posterior capsular folds occurred in 2 eyes of the B2 group(13 eyes).The incidence was 15.4%.There was no significant difference in the occurrence of posterior capsule folds between B1 and B2(P=0.505,P>0.05).Conclusions:(1)The influence of the capsular tension ring may not be uniform in different designs and materials of the IOL.(2)Patients with high myopia cataract who were implanted with CTR combined with Aqua Sense PAL IOL had more accurate results in the accuracy of postoperative refractive prediction than those without CTR.The implantation of CTR helps improve the visual quality of patients.(3)In the selection of Bigbag IOL,the capsular tension ring combined implantation has no significant effect on the refractive status of patients with high myopia cataract.In the short term,there is no difference in the postoperative visual quality,the specific position of the intraocular lens,and no need to adjust the IOL calculate formula and expected degree.(4)CTR to a certain extent can reduce the incidence of posterior capsule folds and posterior capsular opacification(PCO).