CATARACT EWAP DECEMBER 2023 35 Weakened and stretched zonules. Source (all): John Hart, Jr., MD larger than this, a scleral-fixated CTR, like a Cionni ring, is indicated. “There are times where you place a standard CTR but you realize that there is insufficient zonular support,” he said. “In these cases, you can combine a suture-fixated Ahmed capsular tension segment with a standard CTR. I use a sclerally fixated Cionni CTR in all Marfan syndrome patients.” Dr. Hart said he thinks surgeons should practice using CTRs in pseudoexfoliation syndrome patients when the placement is relatively easy. “That way when they encounter more complex zonular abnormalities, they are more comfortable using CTRs,” he said. “It is important to dedicate extra OR time when you are operating on someone with zonular abnormalities. These cases typically take longer than routine cases. There is no shame in referring these patients out to surgeons who routinely handle these cases.” EWAP Reference 1. Page TP, et al. ‘S’ means stop! Critical examination of capsular tension ring movements with Miyake-Apple video analysis. J Cataract Refract Surg. 2021;47:379–384. Editors’ note: Dr. Hart practices with Associates in Ophthalmology, Farmington Hills, Michigan. Dr. McKee practices at East Valley Ophthalmology, Mesa, Arizona. Neither declared any relevant financial interests.
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