Removal of a capsular tension ring from the anterior chamber angle

Abstract

A 75-year-old woman presented with unexplained ocular hypertension 4 weeks after phacoemulsification. Steroid response was diagnosed initially until a misplaced capsular tension ring (CTR) was identified in the drainage angle. We describe the technique used to successfully remove the CTR from the drainage angle with minimal trauma. This case illustrates the importance of the initial surgical technique used for CTR insertion and emphasizes the role of gonioscopy in such a case.

Anterior dislocation of a Morcher capsular tension ring

“…3 To our knowledge, only 1 case of CTR misplacement into the anterior chamber has been reported; it included a description of the removal technique. 4 In this case, the mechanism of dislocation may have been a defective ring or an unrecognized capsule tear.…”

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

“…The presence of CTR was noticed in the early postoperative period and was removed considering long-term complications such as iritis and glaucoma. [ 4 ] In other report, CTR was not occluding angles and managed conservatively. [ 5 ] Mechanism of spontaneous dislocation of CTR in AC has been described by Little et al .…”

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

“…Second, as described by Little et al . [ 2 ] that if CTR is being introduced in an inadequately filled capsular bag, it can hit the equatorial fornix, and with additional force, the ring can rupture through the capsule into the vitreous or be deflected forward out of the bag and into the anterior chamber (AC). This can go unnoticed, particularly in an eye with a well-dilated pupil and when the natural focus of the surgeon is on the entry point of the ring into the bag.…”

“…The presence of a foreign body in the anterior chamber angle can lead to complications such as inflammation,[ 5 ] corneal edema,[ 6 ] and raised intraocular pressure (IOP). [ 2 ] Unilateral raised IOP should always alert the physician to look for secondary causes such as capsular distension syndrome causing forward movement of the intraocular lens and angle closure by pushing mechanism and hydrophobic acrylic intraocular lens in sulcus leading to pigment dispersion glaucoma. [ 7 ] Gonioscopy becomes the most important tool to come to a definite diagnosis in these scenarios.…”

“…For the other cases, the technique shown by Little et al . [ 2 ] can be done. Here, the removal of CTR should be planned by marking the position of eyelet in the anterior chamber by gonioscopy.…”