Misplaced capsule tension ring in anterior chamber: A unique way of explantation

Abstract

We report a patient who presented with endocapsular capsule tension ring (CTR) in iridocorneal angle leading to secondary angle closure glaucoma (ACG) and subsequent removal of the CTR from trabeculectomy ostium. Secondary ACG was diagnosed 2 years and 6 months after cataract surgery in which a CTR was used for zonular instability. CTR removal with trabeculectomy was performed, after which there was the resolution of symptoms. To the best of our knowledge, this is the first case report in which CTR was removed from trabeculectomy ostium. We describe a surgical technique to explant CTR and combining with trabeculectomy.

Capsular tension ring explant complication rate comparison using Miyake-Apple video analysis

“…18,19 In cases of CTRs malpositioned in the anterior segment, surgeons have cited the inability to visualize the CTR as hindrance when attempting to remove a CTR from the ciliary sulcus or angle of the anterior chamber. 20,21 It is the blind nature of both removing and implanting a CTR underneath the iris, out of the surgeon's view that leads to these malpositioned implants and complications. It is for this very reason that the SGCTR technique was developed.…”

“…Cases have been reported of CTRs being inadvertently implanted into the anterior chamber, the sulcus, and posterior segment. [15][16][17] Surgical removal of CTRs from the posterior segment has been described by vitreoretinal surgeons as difficult because of the large diameter of the CTR, citing the limited view of the ring with posterior segment lenses. 18,19 In cases of CTRs malpositioned in the anterior segment, surgeons have cited the inability to visualize the CTR as hindrance when attempting to remove a CTR from the ciliary sulcus or angle of the anterior chamber.…”

Commentary on “Misplaced capsule tension ring in anterior chamber: A unique way of explantation”

“…The occurrence of misplaced capsular tension ring (CTR) in the anterior chamber in the case report by Gala and Khanna. [ 1 ] is only second such case reported in the literature. There are two possible hypothetical reasons for this.…”

“…Gonioscopy helped Gala and Khanna. [ 1 ] to detect CTR in the angle of anterior chamber. In a case report by Saedon et al .,[ 8 ] clinical diagnosis was made in the early postoperstive period by the presence of the peaked pupil.…”

“…The reason could be because only a small portion of CTR was in the anterior chamber. In the case report,[ 1 ] they had an advantage of making trabeculectomy opening in the area corresponding to the end of CTR eyelet. For the other cases, the technique shown by Little et al .…”