Cataract surgery in subluxated lenses with the modified capsular tension ring

The Cionni capsular tension ring has been modified by Professor Boris Malyugin and can now be fully retracted inside an injector tube and implanted through a sub 2 mm corneal microincision.

Speaking at the ESCRS Congress in Paris he said: “Management of congenital and acquired zonular deficiency, such as Marfan syndrome, trauma, pseudoexfoliation syndrome, glaucoma and high myopia have been helped in the past by the endocapsular tension ring (J Cataract Refract Surg. 1998 Oct;24(10):1299-306) but the Cionni Capsular Tension Ring has not been suitable for injection.“

As Professor Malyugin explained that by moving the fixation element to the tip of the ring means it can glide safely along the capsular bag equator without violating its integrity. Duplicature of the ring tips allows for the additional support of the capsular equator opposite to the fixation element.

Experimental research in the form of an eye bank study of just 5 eyes showed easy implantation, easy rotation and easy suture fixation ensuring a stable capsular bag position. In a separate study 18 eyes of 17 patients, 8 of whom had Marfan syndrome, 8 with blunt ocular trauma, 1 with glaucoma + PEX (pseudoexfoliation syndrome) and 1 with PEX results were also promising. Preoperatively, BCVA varied from 20/50 to counting fingers and improved from 20/40 to 20/20 in all cases. The mean follow-up period was 16±4.3 months. In all patients capsular bag centration was achieved. Lens position was verified with ultrasonic biomicroscopy.

PCO (posterior capsule opacification) was the most frequent complication of postoperative period and occurred in 3 eyes, 2 of which required YAG laser capsulotomy.

The results led to Professor Malyugin’s conclusions that the Modified Cionni Capsular Tension Ring (MC CTR) is designed specifically for use during microincision cataract surgery (MICS) and it allows for capsular bag stabilization by securing it to the scleral wall. He believes it to be proven as safe, effective and to provide favourable anatomical and functional results.