Double Capsular Tension Ring (Ctr) In Large Subluxated Cataract: A Novel Technique

To report a cases of large subluxated cataract in which two capsular tension ring (CTR) in opposite orientation was used to stabililize the capsular bag and phacoemulsification was successfully completed

Case was presented in department of Ophthalmology of a tertiary hospital with history of trauma with cricket ball 4 clock hour of inferior subluxation

During capsulorrhexis, to our surprise, it came out to be 6-7 clock hours of inferior subluxation. Unfortunately, due to non-availability of cionnis ring at that time, we used two CTRs for stabilization of bag. After inserting first CTR, the bag was unstable, so second CTR was implanted in the capsular bag . Phacoemulsification was done and 3-piece foldable IOL implanted in the bag. Postoperatively, IOL was well centred

 High density viscoelastic (Sodium hyaluronate 2.3%) was used. Capsulorrhexis was begun from area where zonules were intact, providing better traction.After inserting first CTR, the bag was unstable, so second CTR was implanted in the capsular bag through different side port to maintain diagonally opposite orientation, thereby equally redistributing the centrifugal force. Slow motion phacoemulsification was successfully done under low parameters and 3-piece foldable IOL implanted in the bag. Haptics were placed in the meridian of zonular dialysis

Management of large subluxation is challenging but with advent of close chamber technique and various capsular stabilising devices successful outcome can be achieved in large percentage of cases. Double CTR can be used as an alternative to Cionnis ring, It can give good IOL centration,