Influence of Capsular Tension Ring Implantation on Rotational Stability of Intraocular Lenses: A Systematic Review and Meta-Analysis.

PURPOSE: To evaluate the influence of capsular tension ring (CTR) implantation on the rotational stability of intraocular lenses (IOLs) by separately analyzing IOL rotation and IOL misalignment.

METHODS

PubMed, EMBASE, Web of Science, CENTRAL, and Google Scholar were searched through October 2025. IOL rotation was defined as the absolute axis change from the immediate postoperative position to final follow-up. IOL misalignment was defined as the absolute deviation between the intended surgical axis and the measured postoperative axis. Outcomes included mean rotation or misalignment (degrees) and the proportion of eyes exceeding 5-, 10-, and 15-degree thresholds. Random-effects models were used to calculate pooled mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs). Subgroup analyses were stratified by IOL haptic design and high myopia status. Evidence certainty was assessed using the GRADE framework.

RESULTS

Twelve studies (1251 eyes; 639 CTR, 612 non-CTR) were included. CTR implantation did not significantly reduce mean IOL rotation (MD - 0.40 degrees; 95% CI, -1.20 to 0.39; p = .322). No significant differences were observed for the proportion of eyes with rotation exceeding 5 degrees (p = .150), 10 degrees (p = .065), or 15 degrees (p = .176). For IOL misalignment, the overall pooled effect was not significant (MD - 1.46 degrees; 95% CI, -3.08 to 0.17; p = .079). However, subgroup analysis demonstrated a significant interaction by haptic design (p = .005). CTR implantation significantly reduced misalignment for loop-haptic IOLs (MD - 1.25 degrees; 95% CI, 1.73 to -0.77; p < .001) and for plate-haptic IOLs (MD - 3.18 degrees; 95% CI, -6.29 to -0.08; p = .045). The proportion of IOL misalignment exceeding 5 degrees was significantly lower in the CTR group (RR 0.53; 95% CI, 0.31 to 0.89; p = .018).

CONCLUSIONS

CTR implantation did not significantly reduce mean IOL rotation or the proportion of outlier rotation at final follow-up (moderate-certainty evidence). Exploratory analysis based on very low-certainty observational evidence suggests that CTR may reduce IOL misalignment, particularly for loop-haptic IOLs, but these findings require confirmation in adequately powered RCTs.