MAY 21, 2012
This case series evaluated use of the Cionni-modified capsular tension ring (CTR) in patients with traumatic cataract and loss of zonular support. They report good outcomes with only a few significant complications. I believe this challenging but rewarding technique is underutilized. In my experience it results in a nice, normal two-chambered eye.
Subjects in this retrospective study were 16 patients with traumatic cataract and loss of zonular support who underwent cataract surgery with implantation of a posterior chamber IOL and a 1- or 2-eyelet modified CTR. They implanted the CTRs after lens removal, and there were no cases of extension of dialysis during implantation. Previous studies have found that the ideal timing for Cionni modified CTR implantation in terms of minimizing further zonular stress and capsular destabilization is after lens extraction and decompression of the capsular bag.
The modified CTR allowed in-the-bag IOL implantation and acceptable capsular bag centration intraoperatively. Minimal IOL (grade 1) and capsular bag decentration occurred in the early postoperative period in eyes with a single-eyelet CTR. No eye with a double-eyelet modified CTR had IOL or capsular bag decentration. There were no cases of retinal detachment or other posterior segment complications occurred. Bimanual anterior vitrectomy was required in four eyes.
At a mean follow-up of 12.9 months, CDVA improved in all eyes, with most seeing 20/40 or better. In four eyes with worse than 20/24 vision, the cataract masked pathology that went undetected preoperatively (macular scar, optic atrophy and senile macular degeneration).
They conclude that good visual results indicate that this technique stabilized the capsular bag almost in its physiologic position and prevented posterior dislocation and tilt of the capsular bag–PC IOL complex.