Fcimorcher is implanted and scleral fixated with a 90 prolene suture. Purpose to report the shortterm outcomes and complications of implantation of scleralfixated capsular tension rings andor capsular tension segments with intraocular lenses iol in pediatric. Ophtec capsular tension rings are indicated for the stabilization of the capsular bag. Scleralfixated capsular tension rings and segments for. At the end the ring will be released from the hook. After completion of this educational activity, participants should be able to. The capsule shrinks approximately 10% of its length at when the special radiofrequency probe is applied. Morcher capsular tension rings stabilize the capsule in case of defective or missing zonules. Capsular tension segment cts surgical technique for dislocated. This partial ring is indicated for significant zonular weakness and may be used intraoperatively or as permanent support. The capsular tension segment obviates the need for capsule retractors and their inherent risks lack of equatorial capsule expansion, retractor dislodgement, andor anterior capsule tear andor the capsular tension ring. This young patient presented with an isolated ectopia lentis and superonasal lens subluxation. It is has been shown that the capsular shrinkage acts in several ways to stabilise the.
Late zonule problem sutured capsular tension segment. Intrascleral haptic fixation of capsular tension segment dr. Cionni, md, for cases in which a ctr wouldnt be appropriate. To report the indications and clinical outcomes of all capsular tension ring ctr implantations in a large series of consecutive cataract surgeries during a five year interval in a university eye hospital. Prior to the advent of the capsular tension ring, many of these cases would have required vitrectomy with an anterior chamber or sutured. Millennium surgical has the largest selection of inserter capsular tension ring deliv system and surgical instruments in stock.
Capsule support hooks also have a role in capsular stabilization. Capsular tension rings ctrs are indicated to stabilize weakened, broken or missing zonules, preventing iol decentration after capsular shrinkage. Circular expansion and stabilization of the capsular bag. In order to safely complete the surgery an ahmed capsular tension. Capsular tension rings standard type for cases involving less than 4 clock hours 4 positions of zonular dialysis, a standard ctr is suitable. These devices have enabled many patients with complicated cataracts to safely undergo successful small incision phacoemulsification with insertion of an iol in the capsular bag. Outcome of capsular tension ring ctr implant in complicated. Stepbystep surgical technique for use of the cts for profound zonular weakness during cataract surgery. The techniques and tools for dealing with zonular dehiscence depend on how serious the problem is. However, some patients can have loss of a significant number of zonules.
Teaching video on corneal tattooing with conjunctivoplasty technique dr. Ringject is a preloaded capsular tension ring ctr in a single use injector. Video content accompanies this article at the use of temporary and permanent capsular devices in eyes with compromised zonules advances in ophthalmology and optometry. Bimanual anterior segment revision surgery for anterior. The capsular tension segment can be implanted atraumatically prior to lens. The author demonstrates bimanual,microincisional insertion of. We describe clinical applications and surgical techniques for a new type of capsular tension segment cts for use during cataract surgery. More recently, the modified capsular tension ring and capsular tension segment have been introduced, allowing improved capsular stability and intraocular lens centration by scleralsuture fixation. Retract the empty hook into the injector and remove it from the eye.
However modern thermal capsular shrinkage techniques, as developed at the reading shoulder unit, manipulate the capsular collagen properties only. Capsular tension rings ctrs are polymethyl methacrylate pmma intraocular implantation devices introduced in 1993 by withschel and legler 9,10. Progressive zonulopathy in cases of progressive or advanced zonulopathy, a standard or henderson ctr is unlikely to provide the capsular support needed and will most likely allow the iol to dislocate postoperatively. The ahmed segment is a modified design of the cionni ctr that covers approximately one quadrant with a. Results of intraocular lens implantation with capsular tension ring in subluxated crystalline or cataractous lenses in children. They used a closed ring made of soft silicone with a groove on its inner surface for the loops of the intraocu lar lens iol. Here we show a trick for inserting a capsular tension ring ctr, utilizing the commonlyavailable sinskey hook. Morcher what potential complications are they preventing, pearls for inserting them, and when to remove or retain them zonular weakness makes for. Cionni rj, osher rh, marques dm, marques ff, snyder me, shapiro s 2003 modified capsular tension ring for patients with congenital loss of zonular support. Placement of capsule retractors and insertion of a capsular tension ring are also done. Video created by university of michigan for the course introduction to cataract surgery. Thats why i designed the capsular tension segment, a 90degree pmma partial ring segment that has a 4. One or more segments may be used as necessary to support the areas of the capsule that have damaged or insufficient zonular support.
Recent findings the capsular tension ring, modified capsular tension ring, and capsular tension segment are well. The original ctr was introduced into the market by morcher. The surgical techniques and opinions expressed in the videos are solely those of the surgeons and do not necessarily represent. Its versatility enable early or late placement within the capsular bag. The standard ctr is not meant to be suture fixated. The device, also made of pmma, is a partial ring design spanning 90 degrees with a raised single eyelet centrally, which is designed to sit anterior to the anterior capsule figure 2. The capsule is fixated to the sclera using two ahmed segments so that a toric lens can be placed in the capsular bag. The cionni capsular tension ring ctr is used to stabilize the capsular bag in cases of damaged or missing zonules.
Ahmed segment fixation with 50 prolene sutures eyetube. The ahmed segment is a modified design of the cionni ctr that covers approximately one quadrant with a hole for temporary or permanent fixation. This video demonstrates a surgical technique of capsular tension segment for profound zonular weakness during cataract surgery. Adjunctive surgical devices, such as dyes, pupil expansion rings, and capsular rings and hooks, have added to the safety and efficacy of modern cataract surgery. Capsular tension rings are used to stabilize weakened, broken, or missing zonules during cataract extraction using phacoemulsification and continuous curvilinear capsulorhexis techniques. Ahmeds capsular tension segment is a further modification to the capsular tension ring developed by robert j. The use of temporary and permanent capsular devices in. Connect with your local sales representative or request.
New capsular tension segment with 2point fixation for. As several clock hours of zonules appeared to be damaged it did not seem likely that a simple capsular tension ring ctr would work. This is a young patient with isolated ectopia lentis with superonasal lens subluxation. After these sutures are tied, 2 posterior cannulas are placed between the posterior capsule and the rotator cuff, which allows closure of each capsular disruption with a single absorbable suture that is. The sutures are tensioned, and the sail is raised video 1 to tension the pighl. The study was designed as a restrospective analysis. He was treated by lens aspiration and twopoint capsular support using a modified capsular tension ring mctr and capsular tension segment cts sutured to the sclera along with implantation of a. The capsular tension segment cts was designed with these considerations in mind. Download scientific diagram morcher type 14 ctr open diameter 12. In general, i find that hooks and retractors often cause more problems than they solve. Indications and clinical outcome of capsular tension ring.
Oct 26, 2009 autoplay when autoplay is enabled, a suggested video will automatically play next. Glued endocapsular hemiring segment for sutureless trans. To this point, this technique has only been used once the eye is no longer phakic. Arthroscopic repair of the floating posteriorinferior. Circular expansion and stabilization of the capsular bag s afe iol centration in eyes with zonular dehiscence. Ahmed used a capsular tension segment for the first time. Sep, 20 to report the incidence of anterior capsule contraction syndrome accs and to present a novel minimally invasive bimanual technique for anterior segment revision surgery associated with accs with. However, sometimes, capsular tension ring ctr or modified ctr. Capsular hookassisted implantation of modified capsular tension ring. It can be used in cases that cannot be supported by ctrs it is a partial ring with a fixation hook. Ahmed, university of toronto, canada transcript available soon. Because the entire capsular bag tends to tilt posteriorly in the quadrant of zonular disruption, an ahmed capsular tension segment cts. Indications for use the most appropriate uses for the ctr based on investigative and clinical experience. Morcher capsular tension rings ctrs convert complex cataract cases from compromised zonular integrity into routine cases.
Sep 18, 2012 as several clock hours of zonules appeared to be damaged it did not seem likely that a simple capsular tension ring ctr would work. Inserters consist of a wire with a hook tip, which is used to grasp the capsular tension ring, attached to a plunger and cylinder. Cataract iol dealing with zonular dehiscence by brock k. A 16yearold boy presented with decrease of vision over a period of 2 years. The ability for gas to effectively compress the cleft in the most anterior aspect of the posterior segment is potentially improved with the aphakic capsule with a capsular tension ring in place. Zonular dialysis with ahmed capsule tension segment. Multiple capsular tension rings for the prevention of capsular contraction syndrome 2001 j cataract refract surg 27.
After the capsular tension ring is loaded into the cylinder tip, it is inserted into the lens capsule. Sep 22, 20 stepbystep surgical technique for use of the cts for profound zonular weakness during cataract surgery. Scleralfixated capsular tension rings and segments for ectopia lentis in children. Bayonet fitting allows for easy separation of the center rod and main body. This video demonstrates a surgical technique for combined cataract extraction, iol implantation and mmc trabeculectomy. The ahmed cts is a modified design of the cionni capsular tension rings manufactured by morcher. Read scleralfixated capsular tension rings and segments for ectopia lentis in children, american journal of ophthalmology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Capsular hookassisted implantation of modified capsular. Capsular tension rings ctrs are valuable tools for the cataract surgeon. Since then similar products have been introduced by different manufacturers. Thirteen consecutive pediatric patients 19 eyes underwent placement of inthebag iol with either a cionni modified capsular tension ring or a capsular tension segment in conjunction with a conventional capsular tension ring between january 1, 2009 and march 30, 20 by 3 anterior segment surgeons at a single academic center. Late zonule problem sutured capsular tension segment eyetube. The ctr is a pmma openring device with blunt tipped eyelets at either end. Surgical repair of large cyclodialysis clefts jacob b.
Your browser does not currently recognize any of the video formats available. Central cortical cleanup and zonular deficiency ahmad m mansour,1,2 rafic s antonios,1 iqbal ike k ahmed3 1department of ophthalmology, american university of beirut, beirut, lebanon. He was treated by lens aspiration and twopoint capsular support using a modified capsular tension ring mctr and capsular tension segment cts sutured to the sclera. Pmma capsular tension ring ctr ophtec capsular tension rings are indicated for the stabilization of the capsular bag in the presence of weakened or compromised zonules. The ambati cts is distinguished from other cts devices by having 2 eyelets close to each other, which allows it to distribute tension to 2 points, avoiding too much stress at a single point on the anterior capsulotomy, which prevents peaking of the. Ahmed capsular tension segment cataract surgery with loss of. The cts can be used even when anterior or posterior capsular tears are present. Sep 17, 2008 capsular tension rings ctrs are valuable tools for the cataract surgeon. Wrinkling of the capsule while it is being pinched by capsulorhexis forceps is a sign of weak zonular status.
Inserter capsular tension ring deliv system capsular tension ring inserter delivery system. Glued echr has an open segment design with two arms lying within the capsular fornix and expanding the bag. New capsular tension segment with 2point fixation for zonular weakness j cataract refract surg vol 43. One problem with ctr insertion is that it can become caught or snagged when it engages the peripheral lens capsule, particularly if the capsule is not fully inflated. Glued endocapsular ring glued capsular tension ring glued endocapsular. Evaluation of lens capsule stability using capsular tension ring.
Capsular tension ring ctr insertion pearls using a. As a world leader in the development of cataract surgery devices, fci ophthalmics has worked with reputable manufacturers. Capsular definition of capsular by the free dictionary. Capsular tension segment cts surgical technique for. Capsular tension segment this is a zonular support device that provides support for inthe bag implantation. Deciphering the enigma of astigmatism in cataract surgery. Ahmed capsular tension segment cataract surgery with loss of zonules. Inside the need for capsular tension devices by michelle dalton eyeworld contributing writer the unique design of the henderson ctr eases the cortical removal process source. Optimal timing of capsular tension ring implantation. Insert the injector tip into the capsular bag at 6 oclock and release the ring along the capsular equator clockwise by gently pushing the rod. Morcher capsular tension rings are manufactured from onepiece pmma. Crandalloptimal timing of capsular tension ring implantation.
For cases involving greater than 4 clock hours or progressive zonular damage. The traumatic mydriasis is repaired with the 2interruptedsutures cerclage technique. It is placed in the capsular bag for zonular dehiscence up to 3 or 4 clock hours. Morcher type 14 ctrs are are available in 3 different diameters to accommodate patients individual capsular bags. He was treated by lens aspiration and twopoint capsular support using a modif ied capsular tension ring mctr and capsular tension segment cts sutured to the sclera along with implantation of. A lamellar scleral flap with an underlying 20 g sclerotomy is created centered on the area of dialysis. The use of temporary and permanent capsular devices in eyes. Capsular tension rings ctrs, well known to ophthalmic surgeons, are cshaped devices used to stabilize the capsular bag of the crystalline lens during cataract surgery in eyes with zonular weakness. Injectors are used to implant the morcher capusular tension ring. I have shown via miyaki video that the injector method is much less traumatic than manual insertion. Click here to visit our frequently asked questions about html5. Ahmed capsular tension segment partial ring of pmma covering approximately one quadrant hole for temporary or permanent fixation one or more segments may be used to support the areas of weak capsule devices used in surgery 48. Download recording high quality standard quality december 18, 2019. Morcher capsular tension ring type 14 designs for vision.
The cts is pmma and 120 with an eyelet similar to the cionni modified capsular tension ring ctr that allows for scleral fixation fig. We evaluate the efficacy of capsular tension rings ctrs, iris retractors irs, and capsule expanders ces in. The capsular tension ring a new device for complicated cataract surgery bernd m. Sutured capsular tension rings and segments phaco 3. Cases that were once extremely difficult and challenging can now be addressed routinely with the use of these tools. The ctr is designed to be implanted into the capsular bag and left permanently in place. On examination, he was diagnosed to have microspherophakia with lenticular myopia with secondary glaucoma in both eyes. Video content accompanies this article at the use of temporary and permanent capsular devices in eyes with compromised zonules advances in. Flap motility as a sign of posterior capsule rupture in peripherally extended anterior capsular tears. Ophtec capsular tension rings are indicated for the stabilization of the capsular bag in the presence of weakened or compromised zonules. The capsular tension ring is a sterile, nonoptical ocular implant that is permanently. In 1991, hara and coworkers were the first to publish the idea of inserting an endocapsular ring into the capsular bag 1.
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