Skip to main content
SpringerLink
Log in

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

  • Case Report
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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.

Results

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

Conclusions

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

References

  1. Tribus C, Alge CS, Haritoglou C, Lackerbauer C, Kampik A, Mueller A, Priglinger SG (2007) Indications and clinical outcome of capsular tension ring (CTR) implantation: a review of 9528 cataract surgeries. Clin Ophthalmol 1(1):65–69

    PubMed  PubMed Central  Google Scholar 

  2. Yamane S, Inoue M, Arakawa A, Kadonosono K (2014) Sutureless 27-gauge needle guided intrascleral intraocular lens implantation with lamellar scleral dissection. Ophthalmology 121:61–66

    Article  Google Scholar 

  3. Gimbel HV, Condon GP, Kohnen T, Olson RJ, Halkiadakis I (2005) Late in-the-bag intraocular lens dislocation: incidence, prevention, and management. J Cataract Refract Surg 31:2193–2204

    Article  Google Scholar 

  4. Price MO, Price FW, Werner L, Berlie C, Mamalis N (2005) Late dislocation of scleral-sutured posterior chamber intraocular lenses. J Cataract Refract Surg 31:1320–1326

    Article  Google Scholar 

  5. Yamane S (2016) Transconjunctival intrascleral IOL fixation with double-needle technique, presented at the ASCRS symposium on cataract, IOL and refractive surgery, New Orleans, USA

  6. Masket S, Osher RH (2002) Late complications with intraocular lens dislocation after capsulorhexis in pseudoexfoliation syndrome. J Cataract Refract Surg 28:1481–1484

    Article  Google Scholar 

  7. Jehan FS, Mamalis N, Crandall AS (2001) Spontaneous late dislocation of intraocular lens within the capsular bag in pseudoexfoliation patients. Ophthalmology 108:1727–1731

    Article  CAS  Google Scholar 

  8. Lorente R, de Rojas V, Vazquez de Parga P, Moreno C, Landaluce ML, Domınguez R, Lorente B (2010) Management of late spontaneous in-the-bag intraocular lens dislocation: retrospective analysis of 45 cases. J Cataract Refract Surg 36:1270–1282

    Article  Google Scholar 

  9. Lichtinger A, Kim P, Yeung SN, Amiran MD, Alangh M, Rootman DS (2013) Secondary intraocular lens interventions: predisposing factors, indications and coincident procedures. Int Ophthalmol 33:111–115

    Article  Google Scholar 

  10. Hayashi K, Hirata A, Hayashi H (2007) Possible predisposing factors for in-the-bag and out-of-the-bag intraocular lens dislocation and outcomes of intraocular lens exchange surgery. Ophthalmology 114:969–975

    Article  Google Scholar 

  11. Michaeli A, Soiberman U, Loewenstein A (2012) Outcome of iris fixation of subluxated intraocular lenses. Graefes Arch Clin Exp Ophthalmol 250:1327–1332

    Article  Google Scholar 

  12. Gross JG, Kokame GT, Weinberg DV, for the Dislocated In-The Bag Intraocular Lens Study Group (2004) In-the-bag intraocular lens dislocation. Am J Ophthalmol 137:630–635

    PubMed  Google Scholar 

  13. Kim SS, Smiddy WE, Feuer W, Shi W (2008) Management of dislocated intraocular lenses. Ophthalmology 115:1699–1704

    Article  Google Scholar 

  14. Praveen MR, Vasavada AR, Singh R (2003) Phacoemulsification in subluxated cataract. Indian J Ophthalmol 51(2):147–154

    CAS  PubMed  Google Scholar 

  15. Rai G, Sahai A, Kumar PR (2015) Outcome of capsular tension ring (CTR) implant in complicated cataracts. J Clin Diagn Res 9(12):NC05–NC07

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Hara T, Hara T, Yamada Y (1991) “Equator ring” for maintenance of the completely circular contour of the capsular bag equator after cataract removal. Ophthalmic Surg 22:358–359

    CAS  PubMed  Google Scholar 

  17. Cionni RJ, Osher RH (1998) Management of profound zonular dialysis or weakness with a new endocapsular ring designed for scleral fixation. J Cataract Refract Surg 24:1299–1306

    Article  CAS  Google Scholar 

  18. Nagamoto T, Bissen-Miyajima H (1994) A ring to support the capsular bag after continuous curvilinear capsulorhexis. J Cataract Refract Surg 20:417–420

    Article  CAS  Google Scholar 

  19. Henderson BA, Kim JY (2007) Modified capsular tension ring for cortical removal after implantation. J Cataract Refract Surg 33:1688–1690

    Article  Google Scholar 

  20. Dick HB (2005) Closed foldable capsular rings. J Cataract Refract Surg 31:467–471

    Article  Google Scholar 

  21. Nishi O, Nishi K, Menapace R, Akura J (2001) Capsular bending ring to prevent posterior capsule opacification: 2 year follow-up. J Cataract Refract Surg 27:1359–1365

    Article  CAS  Google Scholar 

  22. Jacob S, Agarwal A, Agarwal A, Narasimhan S, Kumar DA (2014) Glued capsular hook: technique for fibrin glue–assisted sutureless transscleral fixation of the capsular bag in subluxated cataracts and intraocular lenses. J Cataract Refract Surg 40:1958–1965

    Article  Google Scholar 

  23. Kara N (2015) A modified glued transscleral intraocular lens implantation: suture-assisted sutureless technique. J Refract Surg 31(7):488–491

    Article  Google Scholar 

  24. Lang Y, Fineberg E, Garzozi HJ (2001) Vitrectomy to remove a posteriorly dislocated endocapsular tension ring. J Cataract Refract Surg 27:474–476

    Article  CAS  Google Scholar 

  25. Bhattacharjee H, Bhattacharjee K, Das D, Jain PK, Chakraborty D, Deka S (2004) Management of a posteriorly dislocated endocapsular tension ring and a foldable acrylic intraocular lens. J Cataract Refract Surg 30:243–246

    Article  Google Scholar 

  26. Lim MCC, Jap AHE, Wong EYM (2006) Surgical management of late dislocated lens capsular bag with intraocular lens and endocapsular tension ring. J Cataract Refract Surg 32:533–535

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cataract Department, Santa Casa of Belo Horizonte, 197, 1704 – Claudio Manoel Av., Belo Horizonte, Minas Gerais, Brazil

    Sergio Canabrava

  2. Santa Casa of Belo Horizonte, 28, 102 Caraça, Belo Horizonte, Minas Gerais, 30220-260, Brazil

    Leticia Bernardino

  3. Santa Casa of Belo Horizonte, 383, 1203 Padre Rolim, Belo Horizonte, Minas Gerais, 30220-260, Brazil

    Thais Batisteli

  4. Santa Casa of Belo Horizonte, 302, 916 Rio Grande do Norte, Belo Horizonte, Minas Gerais, 30130-131, Brazil

    Gabriella Lopes

  5. Department of Ophthalmology and Otorhinolaryngology, Federal University of Minas Gerais, 190, Prof. Alfredo Balena Av., Belo Horizonte, Minas Gerais, 30130-100, Brazil

    Alberto Diniz-Filho

Authors
  1. Sergio Canabrava
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leticia Bernardino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thais Batisteli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gabriella Lopes
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alberto Diniz-Filho
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sergio Canabrava.

Ethics declarations

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.

Electronic supplementary material

Below is the link to the electronic supplementary material.

10792_2017_746_MOESM1_ESM.mp4

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)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Canabrava, S., Bernardino, L., Batisteli, T. et al. Double-flanged-haptic and capsular tension ring or segment for sutureless fixation in zonular instability. Int Ophthalmol 38, 2653–2662 (2018). https://doi.org/10.1007/s10792-017-0746-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-017-0746-5

Keywords

Search

Navigation