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Using the Ahmed capsule tension segment (CTS) during cataract surgery in patients with pre-existing zonular dehiscence

Poster Details

First Author: S.Koay UK

Co Author(s):    A. Dumitrescu   M. Elgohary                 

Abstract Details


To describe our experience in performing cataract surgery in patients with pre-existing significant zonular dehiscence.


Royal Eye Unit, Kingston Hospital, United Kingdom


Both patients had traumatic cataracts with 5-6 clock hours of zonular dehiscence. At the start of surgery, a 3mm Hoffman scleral pocket was created at the limbus. Dispersive viscoelastic was used to plug the exposed vitreous face. Following capsulorrhexis, 2-3 iris retractors were used to support the capsulorrhexis edge in the area of zonular weakness. This provided additional capsule support during phacoemulsification. An Ahmed CTS was then sutured to the scleral pocket, using 9/0 prolene on a transchamber needle (26-gauge needle used for docking). A 3-piece intraocular lens was then implanted in the bag.


Limited anterior vitrectomy was required in one case, with no other intraoperative complications such as capsular tears or loss of lens fragments posteriorly. Patients were reviewed at 1 day, 1 week, 1 month and 3 months. Mild corneal oedema was seen postoperatively, resolving by 1 month. There was otherwise no cystoid macular oedema or any other significant postoperative complications. Intraocular lenses were well centred and stable in both cases. Best corrected visual acuity improved from 6/24 to 6/9 and CF to 6/12 respectively, and with a final refraction within �Â�±0.50D of target values.


The use of the Ahmed CTS enables successful cataract surgery to be performed using an anterior approach, despite significant zonular dehiscence. It is important to anticipate issues at each step of surgery, and various techniques can be employed to overcome them and avoid further complications. Patients should be counselled about the higher risks of intraoperative and postoperative complications, but ultimately they can achieve good vision once the eye recovers.

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