Capsular Tension Ring Use in High Myopic Eyes Undergoing Cataract Surgery: A Systematic Review and Meta-Analysis.

PURPOSE: To evaluate the impact of capsular tension ring (CTR) implantation on refractive outcomes, intraocular lens (IOL) stability, and postoperative complications in high myopic patients undergoing cataract surgery.

DESIGN

Systematic review and meta-analysis.

METHODS

A systematic search of PubMed, EMBASE, Cochrane Library, and Google Scholar through March 2025 identified studies comparing cataract surgery with and without CTR implantation in high myopic eyes. The primary outcome was prediction refractive error (PE). Secondary outcomes included absolute refractive error (AE), postoperative corrected distance visual acuity (CDVA), IOL decentration, anterior chamber depth (ACD), posterior capsular opacification (PCO), and Nd:YAG capsulotomy rates. Random-effects meta-analysis, sensitivity analysis, and meta-regression were performed.

RESULTS

Nine studies (4 randomized controlled trials and 5 cohort studies; 846 eyes) were included. CTR implantation did not significantly affect PE (mean difference [MD], 0.00; 95% confidence interval [CI], -0.07 to 0.08; P = .93) or postoperative CDVA (MD, 0.00; 95% CI, -0.06 to 0.06; P = 1.00). However, CTR significantly reduced AE (MD, -0.12; 95% CI, -0.20 to -0.05; P = .001) and IOL decentration (MD, -0.04; 95% CI, -0.07 to -0.01; P = .004).No covariates significantly influenced PE in meta-regression.

CONCLUSIONS

CTR implantation appears to modestly improve refractive predictability and IOL stability in high myopic eyes without compromising postoperative visual acuity. However, given the limited evidence base and small effect sizes, these findings should be interpreted with caution. CTR implantation may be considered in selected myopic cases with suspected zonular weakness or large capsular bags where additional capsular stability is desired.