International Ophthalmology

, Volume 38, Issue 6, pp 2653–2662 | Cite as

Double-flanged-haptic and capsular tension ring or segment for sutureless fixation in zonular instability

  • Sergio CanabravaEmail author
  • Leticia Bernardino
  • Thais Batisteli
  • Gabriella Lopes
  • Alberto Diniz-Filho
Case Report



This paper introduces a surgical technique for the sutureless management of zonular dialysis greater than 120° using a capsular tension segment (CTS) or a modified capsular tension ring (m-CTR; CTR with suturing eyelets) and a haptic removed from a 3-piece polypropylene IOL.


A CTR is used as normal. Cataract removal is followed by connection of the CTS or m-CTR to the single haptic and created using heat to make a flange in one haptic’s extremity. The other extremity is placed in the CTS or m-CTR’s central hole. The CTS or m-CTR/flanged-haptic complex is introduced into the capsular bag and aligned with the weakest zonular quadrant. A 30-gauge needle guides the externalization of the free haptic extremity through the adjacent pars plana and creates a flange on the second haptic tip permitting intrascleral fixation of the CTS or m-CTR.


The result is a successful IOL implantation with a sutureless technique.


This double-flanged m-CTR/CTS technique allows suture-free option for managing zonular weakness or dialysis while performing cataract surgery.


Cataract removal Capsular tension ring Subluxated Cataract 


Compliance with ethical standards

Financial disclosure

The corresponding author has a pending patent in PCT to produce a CTR/CTS device that can be used in this technique. There are no other financial interests or conflicts to disclose for any of the authors.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Patient consent

The patient has consented to the submission of the case report to the journal.

Supplementary material

10792_2017_746_MOESM1_ESM.mp4 (21.4 mb)
A haptic is removed from a 3-piece IOL, and one end of the haptic is heated and shaped into a flange. This haptic is connected to a CTS or m-CTR. A standard CTR is inserted to redistribute capsular forces, expand the fornix, and decrease flaccidity of the posterior capsule. Phacoemulsification and cortex aspiration are performed to remove the cataract. The other end haptic is placed in the center hole of the CTS or m-CTR, forming a CTS or m-CTR/flanged-haptic complex. This complex is introduced into the capsular bag and aligned with the weakest zonular quadrant. A 23-gauge micro-forceps is used to place the flanged-haptic end into the eye of a 30-gauge guide needle. The threaded needle is used as an external guide of the haptic’s end within the sclera. The second haptic tip is then be bent into a flange (using heat). IOL implantation is performed following standard protocol. Finally, external flanged haptic is then inserted into the sclera. Supplementary material 1 (MP4 21902 kb)


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Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  1. 1.Cataract DepartmentSanta Casa of Belo HorizonteBelo HorizonteBrazil
  2. 2.Santa Casa of Belo HorizonteBelo HorizonteBrazil
  3. 3.Santa Casa of Belo HorizonteBelo HorizonteBrazil
  4. 4.Santa Casa of Belo HorizonteBelo HorizonteBrazil
  5. 5.Department of Ophthalmology and OtorhinolaryngologyFederal University of Minas GeraisBelo HorizonteBrazil

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