Placement of dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis

Abstract

Background: To evaluate the efficacy and safety of placing dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis.

Methods: A modified capsular tension ring was inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring was inserted into the capsular bag in 20 eyes in 20 consecutive patients showing signs of ocular hypotony and ectopia lentis. Outcome measures included intraocular pressure, best-corrected visual acuity, and postoperative complications.

Results: Dual capsular tension ring placement was performed in 20 patients with a mean age of 48.7 years. The cyclodialysis cleft extended over 2.9 clock hours (range 0.5-6.5). The modified capsular tension ring was successfully inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring in the capsular bag in all eyes. At the last follow-up, the cyclodialysis cleft was closed in 16/20 (80.0%) eyes. The intraocular lens was stable in all patients postoperatively. Best-corrected visual acuity, in terms of the logarithm of the minimal angle of resolution, improved from 1.3 ± 0.8 before surgery to 0.4 ± 0.3 after surgery (P < 0.001). Intraocular pressure increased significantly from 10.6 ± 3.2 mmHg before surgery to 13.0 ± 4.8 mmHg after surgery (P = 0.040). Postoperative complications included a painful reversible intraocular pressure spike in four patients (20.0%). Logistic regression revealed no significant factors associated with successful cleft closure and a stable final intraocular pressure of ≥ 10 mmHg.

Conclusions: The placement of two capsular tension rings into the ciliary sulcus and the capsular bag is a safe, successful procedure combined for repairing a traumatic cyclodialysis cleft and managing zonular dialysis.

Keywords: Capsular tension ring; Combined surgery; Cyclodialysis cleft; Zonular dialysis.

Fig. 1

Surgical microscopic images showing insertion of a combined Cionni-modified capsular tension ring (MCTR) into the capsular bag and an MCTR into the sulcus for repairing cyclodialysis cleft and zonular dialysis. a Ectopia lentis with a round capsulorhexis in a patient of cyclodialysis cleft. b Fixation of two capsule hooks for capsular support. c Insertion of an MCTR with one eyelet into the capsular bag. d Implantation of an intraocular lens into the capsular bag. e Insertion of an MCTR with two eyelets into the ciliary sulcus. f Separation of the sutures that fix the eyelets of both MCTRs

Fig. 2

Preoperative clinical images in representative cases of cyclodialysis cleft and zonular dialysis. a & b Preoperative ultrasound biomicroscopy image showing cyclodialysis cleft and zonular dialysis for the same patients. c Preoperative B-scan ultrasonographic image showing the detachment of choroid. d Preoperative slit-lamp biomicroscopic photograph showing temporal iridodialysis, zonular disruption with a subluxated lens, and a posterior subcapsular cataract

Fig. 3

Postoperative ultrasound biomicroscopy images of dual capsular tension rings insertion in the ciliary sulcus and the capsule. a & b Ultrasound biomicroscopy showing a double indentation sign (arrow) after inserting a Cionni-modified capsular tension ring in the ciliary sulcus and a capsular tension ring in the capsular bag. The two arc-shaped strong echoes with multiple reflections on the picture indicate the Cionni-modified capsular tension ring (*) and the capsular tension ring (#) (The two pictures below are taken from the same patient)