Intraocular lens optic capture in eyes with zonular weakness

Abstract

Devranoğlu et al.1 described the use of microhook iris retractors to fixate the capsulorhexis, capsular tension ring (CTR), and intraocular lens (IOL) optic capture in eyes with zonular weakness. They considered placing the haptics in the sulcus and IOL optic capture through an anterior capsulorhexis preoperatively when zonular weakness is identified, without a capsule tear and vitreous loss. They suggest that haptics in the sulcus and IOL optic capture though the capsulorhexis is useful in secondary procedures for decentered IOLs that must be repositioned or when in-the-bag IOLs must be replaced for reasons such as optical degradation from neodymium:YAG pits or crystallization. Microhooks in the form of iris retractors2 and capsule stabilization devices such as a capsule retractor3 have been proposed for capsular bag stabilization during cataract surgery to avoid stress on the remaining zonular fibers. We have observed that IOL haptics in the capsular bag provide additional support: The haptics expand the capsular bag and recruit and redistribute tension among existing zonular fibers, which leads to reinforcement of areas of weak fibers and recentration of a mildly subluxated capsular bag. We have noted better results when IOL haptics are positioned against the subluxated area. Additionally, with the CTR–IOL complex, resuturing the subluxated complex to the sclera or explanting it and implanting a secondary anterior chamber IOL makes surgery easier.4,5