Capsular bag shrinkage after implantation of a capsular bending or capsular tension ring

PURPOSE: To evaluate the influence of a capsular bending ring (CBR) or tension ring (CTR) on capsular bag shrinkage. SETTING: Department of Ophthalmology, Johannes Gutenberg-University, and Department of Medical Biometry, Epidemiology and Informatics, University of Mainz, Mainz, Germany. METHODS: In 92 eyes of 92 patients, a capsular measuring ring (CMR) was implanted after phacoemulsification to measure capsular bag size in vivo. Patients were randomized into 3 groups: The first received a CMR and CBR, the second received a CMR and CTR, and the third received a CMR alone. Measurements were performed preoperatively, intraoperatively, during the first 3 postoperative days, and after 1 and 3 months. Preoperative biometric characteristics such as axial length (AL) and anterior chamber depth were determined. Primary clinical end points were capsular bag size and capsulorhexis diameter measured intraoperatively and by means of slitlamp biomicroscopy and retroillumination photography postoperatively. RESULTS: There were no clinically relevant group differences in AL, anterior chamber depth, or capsulorhexis diameter. Eyes implanted with the CBR showed shrinkage of the capsular bag from 10.6 to 10.4 mm after a median of 3 months (sign test; P = .023); eyes with a CTR showed comparable median capsular bag shrinkage from 10.5 to 10.2 mm (P<.001), whereas eyes without a CTR showed a median shrinkage from 10.5 to 10.0 mm (P<.001). Intraindividual shrinkage was of a similar, although significantly different, order among these groups (median shrinkage 0.15 versus 0.23 and 0.38 mm, respectively; all pairwise Wilcoxon test; P = .050, P = .020, P<.001, respectively). CONCLUSIONS: Capsular shrinkage can be inhibited by a CBR and, to lesser extent, a CTR; the gain in shrinkage prevention is limited when compared with a CMR, however. This conclusion can be drawn only for the specific CBR or CTR and hydrophobic acrylic intraocular lens (IOL) used in this study. Reduction of capsular bag shrinkage after CTR implantation may reduce IOL dislocation and tilt and help to maintain postoperative visual acuity.