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Purpose To describe a patient who developed radial displacement of the capsular bag and toric intraocular lens implant within approximately 5 weeks after surgery. Observations A patient underwent uncomplicated cataract extraction and implantation of a toric IOL for 2.5 diopters (D) of preoperative corneal astigmatism. Uncorrected visual acuity (UCVA) on postoperative day 1 was 20/20. Blurriness developed 5 weeks after surgery when UCVA was 20/70 but corrected to 20/20 with 2 D of cylinder in a new axis. The IOL was in the proper axis, but it and the capsular bag were radially displaced. Dilated examination revealed posterior capsular opacification superotemporally, outside the visual axis. The patient's biometry revealed axial myopia and megalocornea (white-to-white measurement of 13.44 mm), suggesting a larger than average capsular bag. Surgery was performed at postoperative week 6 to expand the capsular bag using a capsular tension ring and to re-center the IOL keeping the same axis. The patient recovered UCVA of 20/25 after the IOL was recentered. Conclusions and Importance It is important to review biometry for large white-to-white measurements. Eyes with megalocornea may require capsular tension rings at time of toric IOL implantation so as to maintain IOL centration and good UCVA.

The surgical management of cataract associated with extensive zonular loss presents a challenge for ophthalmic surgeon. Capsular Tension Ring (CTR) is commonly being used to stabilize the capsular bag in patients with zonular dialysis. CTR helps to avoid capsular collapse and vitreous presentation in AC during surgery and maintains the capsular bag, allowing the circular contour of the capsular bag, allowing intra ocular lens to be easily placed in the bag. The aim of the study was to know if there is any shift of IOL following use of CTR ring.We did a Ultrabiomicroscopy (UBM) examination to find out shift in PCIOL in cases in which CTR ring and compared it with cases without CTR ring.It was found out through UBM in this study that there is actually a posterior shift of PCIOL after use of CTR ring leading to hypermetropic correction needed after surgery.It is suggested that posterior shift of IOL following use of CTR should be kept in mind and the IOL implanted should be of + 1.0 to 2.0 D more than that calculated preoperatively.

To evaluate the safety and efficacy of the Ophtec capsular tension ring (CTR) in providing capsular support during and/or after cataract extraction in cases of a weak or partially broken ciliary zonule.Phase III multicenter, nonrandomized, investigational device study.Twelve investigators at 9 sites enrolled 224 subjects and placed 255 CTRs.Capsular tension rings were placed in patients who were found to have a weakened or partially broken ciliary zonule comprising34% of the circumference of the lens capsule. Two CTR models were evaluated, with noncompressed diameters of 12 mm and 13 mm. Patients were examined preoperatively, intraoperatively, and postoperatively at day 1 and months 1, 3, 6, and 12.Rate of successful stabilization of the capsular bag and intraocular lens (IOL) centration, complications, and adverse events.Interim results from this ongoing study indicate that immediately after surgery 98.8% of IOLs were centered and 1.2% of the IOLs implanted (3/251) were not centered. Subsequently, the prevalence of decentered IOLs was 1.7% (4/236) 3 months after surgery, 3.8% (8/211) 6 months after surgery, and 2.3% (4/172) 12 months after surgery. The primary complication was posterior capsular opacification, which is unlikely to be a complication of CTR insertion. Neodymium:yttrium-aluminum-garnet laser capsulotomies have been performed in 12.8% of eyes by 12 months (22/172).Ophtec CTR models 275 and 276 safely provided capsular support during and after cataract surgery in cases where the zonule was weak or partially broken.

Background A child with microspherophakia is described who was managed with scleral fixation of the loose capsular bag using Ahmed capsular tension segment and the small capsular bag was expanded using a standard capsular tension ring. Methods The child presented initially with lenticular myopia and concomitant glaucoma for which he was treated with peripheral iridotomy alone. The IOP remained uncontrolled after iridotomy procedure. Therefore, bimanual clear lens aspiration was performed; standard capsular tension ring was implanted ‘in the bag’ and Ahmed capsular tension segment was sutured to the sclera to stabilize the capsular complex. Foldable acrylic IOL was then injected into the bag. Results Postoperatively, the child had an unaided acuity of 20/30 on ETDRS. The IOL was centered well and the capsular bag had expanded due to the effect of CTR. Conclusions This ‘dual support’ technique takes advantage of using both CTR and CTS to overcome the generalized zonulopathy found in cases of microspherophakia. It effectively counteracts lenticular myopia, treats glaucoma, strengthens the capsular bag and does not entail the future risk of IOL-bag dislocation.

Purpose To report a new technique for safely and quickly removing a displaced capsular tension ring from the vitreous cavity. Design Two interventional case reports. Participants The authors retrospectively reviewed the charts of two patients with displaced capsular tension rings (CTRs). Intervention Surgical removal of the displaced CTRs was performed in two patients. Main outcome measures Visual and anatomic outcomes. Results The CTRs were removed surgically, in case 1 by cutting the CTR into two pieces before removal and in case 2 by using the CTR injector to remove the CTR in one piece through a sclerotomy site. Both patients had good visual and anatomic outcomes. Conclusions The described technique of removing a displaced CTR in one piece through a sclerotomy site using the CTR injector provides a safe and efficient method of CTR removal. Cutting the CTR into two or more pieces for removal is not recommended.

Introduction Posterior capsule opacification (PCO) still remains one of the major complications in cataract surgery. Problems especially emerge with the design of accommodative and multifocal intraocular lens (IOL). For proper function these IOLs require elastic lens capsules without any tendency of after cataract formation to avoid reduced mobility of the IOL and IOL decentration. Furthermore future concepts of presbyopia correction such as injectable IOL materials also highly depend on elastic lens capsules without any capsule opacification. Material and methods The most accepted concept of PCO prevention today is the sharp edge design of an IOL. The sharp edge independently of IOL material can inhibit PCO development. Other current investigated strategies focus on the genetic and pharmacological manipulation of lens epithelial cells (LEC) or on the removal of these cells. A new in vitro PCO model for testing new strategies and substances which could influence LEC growth will be presented. This model is based on the stabilisation of the capsular bag by a capsular tension ring (CTR). It offers excellent stabilisation of the capsule and physiological conditions in organ culture. The influence of different CTRs on PCO was evaluated. We found, that CTRs do not completely prevent PCO development in vitro , however different CTR designs show different shapes of capsule expansion and different pattern of LEC growth. Cystamine, β-lactose and alkylphosphocholine, all antiproliferative but non toxic substrates were tested: Although none of the substances evaluated could fully prevent LEC migration in the in vitro PCO model, β-lactose and alkylphosphocholine were highly effective in delaying LEC migration on the capsule bag when compared to untreated LEC. In a third approach the laser photolysis system of A.R.C Laser ® was adapted for capsule polishing by ablation of LEC. After cataract extraction multiple laser pulses were applied to mechanically remove LEC. The lowest efficient energy necessary for removal of LEC was evaluated in the in vitro model. Conclusion The introduced in vitro model offers an easy and safe way to investigate the impact of innovative approaches on PCO prevention.