Modified injector for optimal insertion of standard CTRs in lax zonules.

Abstract

Capsular tension rings (CTRs) are commonly used for stabilizing the capsule in lax zonules. Blind and uncontrolled maneuvering of the ring free end may cause intraoperative incidents during CTR insertion. We improved the design of a standard CTR typical injector that eliminates the risks associated with the lack of control during its insertion. We present a modification of a typical injector used for insertion of standard CTR as well as the insertion technique. The modification consists of a metal anchoring element attached to the free end of the tube, on which the second eyelet of a standard CTR is fixed. The device was used in the surgical treatment of 50 adult patients with cataract associated with lax zonule. The improved injector led to a reduced injection duration and complexity, and there were no intraoperative incidents or postoperative complications. The fixation of the second eyelet allows a controlled insertion of the standard CTRs, which facilitates the intraocular implantation technique, reduces surgical complications associated with the blind maneuvering of the free end of the ring inserted by traditional methods, and has a less disruptive action on the integrity of the remaining undamaged zonular fibers in the lax zonules. The accessory attached to the typical injector tube reduces the risk of surgical incidents caused by the uncontrolled progression of the ring's free end inside the capsular bag.