Modified capsular tension ring implantation in eyes with traumatic cataract and loss of zonular support

Buttanrı, İbrahim Bülent; Sevim, Mehmet Şahin; Esen, Didem; Acar, Banu Torun; Serin, Didem; Acar, Suphi

doi:10.1016/j.jcrs.2011.10.029

Cited by 24 publications

(12 citation statements)

References 16 publications

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“…Early decentration of a modified CTR-IOL complex was reported by Buttanri et al 8 They stated that unopposed traction of sutures and a modified CTR in the direction of the fixation site resulted in zonular dehiscence in the opposite weak zonular fibers that had been assessed as healthy intraoperatively. However, because of the minimal extent, no surgical intervention was done in these cases.…”

Section: Discussionmentioning

confidence: 92%

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Sequential and simultaneous capsular bag fixation in subluxated lens using dual support

Khokhar

Angmo

Aron

2013

JCRS Online Case Reports

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We describe the case of a 47-year-old man with bilateral inferiorly subluxated cataractous lenses of idiopathic etiology (z 9 clock hours of subluxation). Phacoemulsification and insertion of a single eyelet Cionni ring with a posterior chamber intraocular lens (PC IOL) were performed in the right eye. On the first postoperative day, there was a significant superior decentration of the PC IOL, with the inferior part of the Cionni ring visible in the pupillary axis. This was corrected by implanting a capsular tension segment (CTS) inferiorly. In the fellow eyes, a planned simultaneous Cionni and CTS insertion was performed and achieved adequate centration. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. JCRS Online Case Reports 2013; 1:e33-e36 Q 2013 ASCRS and ESCRS Subluxated cataractous lenses are among the most challenging cases encountered by the cataract surgeon. However, after the introduction of a modified capsular tension ring (CTR) (Cionni ring) by Cionni and Osher 1 and Cionni et al. 2 and a capsular tension segment (CTS) by Hasanee et al., 3 better stability and centration of the capsular bag have been noted, especially in severe and progressive cases of zonular deficiency.We report the clinical presentation and follow-up of a case with bilateral 270-degree subluxated cataractous lenses (idiopathic etiology) managed by phacoemulsification with implantation of a posterior chamber intraocular lens (PC IOL) and Cionni ring 4-8 followed by a CTS in a staged manner in the right eye versus simultaneous Cionni ring, PC IOL, and CTS insertion in the same sitting in the fellow eye. To our knowledge, the use of different approaches in 2 eyes of a patient has not been reported. CASE REPORTA 47-year-old man presented with gradual, painless, and progressive diminution of vision in his right eye more than in his left eye over the past year that did not improve with spectacle correction. The patient had used spectacles for the past 20 years with a corrected distance visual acuity (CDVA) of 20/20 in both eyes until 1 year earlier. There was no history of trauma, pain, redness, floaters, or intraocular surgery and no associated systemic disease.The patient was of average build and the systemic examination normal. On ocular examination, the CDVA was 20/120 in the right eye and 20/60 in the left eye. The near vision was Jaeger (J)18 and J12, respectively. The intraocular pressure (IOP) was 16.18 mm Hg in both eyes on applanation tonometry. Iridodonesis with phacodonesis was noted in both eyes. On full dilation, 270 degrees of inferior subluxation of the lens was noted from 8 o'clock to 4 o'clock in both eyes and the zonules, which were visible superiorly, were intact but subluxated (Figures 1, A, and 2, A and B). The lens was cataractous with grade 1 nuclear sclerosis and a mild posterior subcapsular cataract in the right eye more than in the left eye. On fundus examination, the disc and macula were healthy with a sharp foveal reflex and no treatable lesion in t...

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Section: Discussionmentioning

confidence: 92%

“…Several surgeons have used 2-eyelet Cionni rings in such cases. 3,4,8,10 However, Moreno-Montañ es et al 4 have described tearing of the capsulorhexis immediately after implantation when the 10-0 polypropylene sutures were pulled in opposite directions from both hooks. Our experience with the double-eyelet Cionni was similar in the past.…”

Section: Discussionmentioning

confidence: 99%

Sequential and simultaneous capsular bag fixation in subluxated lens using dual support

Khokhar

Angmo

Aron

2013

JCRS Online Case Reports

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“…This method provides safer options for the patient because the capsule is fixated in the sclera. (14) However this instrument isn't available on our operating room at that time.…”

Section: Discussionmentioning

confidence: 99%

Phacoemulsification with combination of CTR and Iris Hook in Subluxated Cataract

Abdurrauf¹,

Hermawan²

2021

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Purpose: To report a management of challenging case of phacoemulsification in cataract with subluxated lens. Methods: A 63 male patient referred to RSDS with secondary lens induced glaucoma and cataract with subluxation around 210O on left eye. Patient was planned to undergone Phacoemulsification with combination of CTR and Iris Hook for lens extraction. Result: Postoperative result is satisfactory with minimal corneal edema. After 6 weeks of follow-up uncorrected vision is 5/8 with correction of S+0.25 became 5/5 and IOP is stable at 17 mmHg and the IOL was in placed in the bag and well centered. Conclusion: Phacoemulsification with iris hooks combined with CTR is one of surgery option that is safe and widely attainable for cataract with subluxated lens.

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“…Some studies found that capsule tension ring not only enhanced the safety of cataract surgery, but also reduced posterior capsule opacification. In addition, studies indicated that capsule tension ring also increased the stability of intraocular lens and vision [38].…”

Section: Plos Onementioning

confidence: 99%

The effect of capsule tension ring on posterior capsule opacification: A meta-analysis

et al. 2021

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Background Posterior capsule opacification is one of the most common complications after cataract surgery. Studies have suggested that the introduction of a capsule tension ring might play a critical role in the prevention of capsule opacification, yet quantitative evidence is still lacking. This work consists of a meta-analysis on available data in order to explore the influence of a capsule tension ring on posterior capsule opacification. Methods A comprehensive review of the literature on capsule tension ring and posterior capsule opacification was carried out using the Embase, Pubmed, Web of Science, and Cochrane electronic databases. The selected studies included randomized controlled trials, retrospective studies and prospective studies published before June 2020. The studies of interest were selected by two reviewers independently from the included studies. Odds ratios (ORs) and standardized mean differences (SMD) were used in order to assess the association. A fixed-effects model or a random-effects model was applied to combine data according to heterogeneities. Sensitivity analysis was used to assess the heterogeneity of the studies. Publication bias was estimated using the Egger test. Statistical analysis was performed using the stata15.1 software. Results The meta-analysis included in total 8 studies involving 379 cases and 333 controls. There was a statistically significant difference of Nd:YAG laser capsulotomy rate (OR=0.241, 95% CI: 0.145, 0.400 I2=42.1%) between the capsule tension ring group and the control group, indicating that the tension ring reduced the Nd:YAG laser capsulotomy rate. Further studies with continuous data also revealed that the use of capsule tension ring was associated with a lower posterior capsule opacification score (SMD = -1.402, 95% CI: -2.448, -0.355 I2=95.0%). The sensitivity analysis suggested that the result of the re-combined analysis did not change notably, indicating that the result was reliable and stable. Both pooled analysis showed no evidence of publication bias. Conclusion The findings of this meta-analysis confirmed that capsule tension ring might reduce capsule opacification. Further studies should be made to validate the result.

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Modified capsular tension ring implantation in eyes with traumatic cataract and loss of zonular support

Abstract: No author has a financial or proprietary interest in any material or method mentioned.

Cited by 24 publications

References 16 publications

Sequential and simultaneous capsular bag fixation in subluxated lens using dual support

Sequential and simultaneous capsular bag fixation in subluxated lens using dual support

Phacoemulsification with combination of CTR and Iris Hook in Subluxated Cataract

The effect of capsule tension ring on posterior capsule opacification: A meta-analysis

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