Effect of Capsular Tension Ring on Toric IOL Stability and Visual Outcomes in Cataract Patients with High Myopia:A Cohort Study including Two Types of Toric IOL

To evaluate capsular tension ring (CTR) impact on toric intraocular lens (IOL) stability in high axial myopia (AL≥26 mm). 10th People's Hospital Affiliated to Tongji University, Shanghai, China. Ambispective cohort study. 90 eyes (68 patients) received CTR with toric IOL (CTR group, n=55) or toric IOL alone (control, n=35). Outcomes included rotational stability, decentration, tilt, residual astigmatism, and visual acuity at 1 week and 3 months. Statistical analyses incorporated t-tests, Kaplan-Meier survival analysis, and generalized estimating equations (GEE). CTR improved early rotational stability (3.20±5.23° vs 4.26±3.68°, p=0.03) and reduced ≥10° rotation incidence (1.8% vs 12.9%, p=0.04). At 3 months, CTR decreased decentration (0.28±0.14mm vs 0.43±0.37mm, p=0.04) without affecting tilt. In AL≥30 mm subgroup, CTR reduced residual astigmatism (1 week: p=0.04) and delayed ≥10° rotation onset (p=0.003). Plate-haptic IOLs had higher rotation risk than C-loop designs (RR=6.613, p=0.01), but CTR reduced tilt in plate-haptic subgroup (0.96° vs 2.03°, p=0.005). Advanced age independently lowered rotation risk (RR=0.89, p=0.004). CTR enhances rotational stability and reduces decentration in high myopia, particularly for AL≥30 mm eyes. C-loop IOLs outperform plate-haptic designs in rotation resistance. Age is a protective factor against rotation. These findings support CTR use with plate-haptic IOLs in elongated eyes to optimize outcomes.