Microincision multifocal intraocular lens with and without a capsular tension ring: optical quality and clinical outcomes

PURPOSE: To study the effect of a capsular tension ring (CTR) on the visual, refractive, and intraocular optical quality of a multifocal intraocular lens (IOL) with diffractive asymmetrical light distribution. SETTING: Vissum-Instituto de Oftalmológico de Alicante, Alicante, Spain. METHODS: An Acri.Lisa 366D IOL was implanted without CTR implantation in 54 eyes (Group 1) or with Acri.Ring BR 11 CTR implantation in 40 eyes (Group 2). Intraocular optical quality in vivo was characterized by the difference between the postoperative total and corneal optical aberrations. Visual, refractive, and intraocular optical outcomes were evaluated 3 months postoperatively. Main outcome measures included postoperative residual refraction, uncorrected and corrected far and near visual acuities, intraocular aberrations, the Strehl ratio, and the modulation transfer function (MTF). RESULTS: The postoperative means in Group 1 were spherical equivalent, 0.31 +/- 0.45 diopters (D); uncorrected distance acuity, 0.79 +/- 0.19; best corrected distance acuity, 0.95 +/- 0.11; uncorrected near acuity, 0.77 +/- 0.21; best corrected near acuity, 0.89 +/- 0.14; best distance-corrected acuity, 0.90 +/- 0.12. The Group 2 means were -0.18 +/- 0.60 D, 0.74 +/- 0.23, 0.98 +/- 0.07, 0.72 +/- 0.22, 0.86 +/- 0.14, and 0.86 +/- 0.14, respectively. Group 2 had a statistically significant reduction in intraocular aberrations and a significant increase in MTF values and Strehl ratios compared with Group 1. CONCLUSION: Combined use of the CTR and Acri.Lisa 366D IOL provided good efficacy, predictability, and safety and increased the intraocular optical performance, suggesting better IOL stability.