Sulcus fixation of a standard capsular tension ring in cataract surgery with capsular instability

To introduce a novel technique for stabilizing the capsular bag in cataract surgery.

This retrospective observational case series included eyes with unstable capsular bag that underwent cataract surgery. A standard capsular tension ring (CTR) with 10-0 Prolene sutures was inserted into the capsular bag and fixated to the sulcus to stabilize the bag, enabling in-the-bag intraocular lens (IOL) implantation. Uncorrected distance visual acuity, corrected distance visual acuity (CDVA), and slit-lamp examination were performed preoperatively and at 1 and 6mo postoperatively.

Of the 17 eyes from 15 patients (mean age 51.20±19.60y, male/female=11/6), 8 had subluxation due to Marfan syndrome, 3 due to trauma, 5 due to zonular weakness, and 1 due to acute angle closure glaucoma. The preoperative mean CDVA (logMAR) was 0.56±0.67 (mean spherical equivalent: −6.39±4.78 D). At 1mo postoperatively, the mean CDVA improved to 0.21±0.37 (mean spherical equivalent: −0.35±1.07 D). At 6mo, the mean CDVA was 0.32±0.39, and the mean spherical equivalent was −0.34±0.99 D. All patients showed significant visual improvement at both postoperative visits (P<0.05), with stable IOLs in all cases.

This technique offers a viable surgical option in complex cataract cases with zonulysis.