Loop-on-suture-guided insertion for easier capsular tension ring insertion and residual cortex removal

Abstract

The capsular tension ring (CTR) is a useful aid in cataract surgery involving zonular impairment. In standard implantation with tweezers or injectors, there is limited control of the leading eyelet, and this can cause excessive stress on the zonular fibers and lead to damage of the capsular bag. Several techniques have been investigated with the aim of reducing these risks. In this study, a simple new modification of the suture-guided CTR technique is described. Adding a loop to the suture can facilitate manipulation during implantation and removal of cortex residues at the end of cataract extraction.

Loose zonules in cataract surgery

“…Some surgeons opt to thread the leading eyelet with temporary suture to act as a tether that can be held as the CTR is manually placed in the bag as well as to provide a visual cue of the location of the CTR during insertion [7]. Loop-on-suture modifications of this technique have been developed where a loop created on the suture affixed to the trailing eyelet of the CTR can further facilitate CTR insertion as well as cortex removal [8 ▪ ]. Prior to injecting a CTR, the capsular bag should be inflated with viscoelastic, and the CTR should be injected toward intact zonules and away from zonular defects.…”

Use of filaments on CTR eyelets to allow its insertion and manipulation in an isometric manner

“…Use of filaments on CTR eyelets to allow its insertion and manipulation in an isometric manner I was interested in a recent article, in which a suture loop on the frontal eyelet of a capsular tension ring (CTR) prevents zonule unzipping during implantation. 1 The authors cited recent procedures that used a suture on the CTR eyelet to reduce the zonule stress during the insertion or explantation in aborted cases.…”

“…During standard implantation, the remaining zonular fibers are stressed. 1 Moreover, the leading eyelet, inserted without visual control, can penetrate the affected lens equator. CTR eyelet guidance minimizes both the zonular tension and the risk for capsular damage.…”

Reply: Loop-on-suture-guided insertion for easier capsular tension ring insertion and residual cortex removal

“…The large loop enables Kuglen hook manipulation. 3 That there is only one knot may be an advantage over your method. We appreciate the advantages of your technique: the safer bidirectional CTR movement and the secured insertion of the trailing eyelet.…”