Flanged Cionni Ring Suture For Resolving Lens Bag Subluxation And Comparison With Previous Cionni Ring Suturing Under Scleral Pocket Technique Used In Ectopia Lentis

Previously we presented a scleral-pocked based approach for suturing Cionni ring in paediatric lens subluxation (ESCRSC22-CC-1564 and ESCRS24-FP-4619). Presently we have approached using a flange-suture instead of the scleral pocket and would like to weigh our findings on the advantages and possible disadvantages of this technique versus the previous.    

Retrospective case report.

A 56-year-old patient was referred to our department for left eye traumatic cataract. Previously in 2012 the patient suffered a perforative ocular trauma on the right eye which could not be salvaged and was thus treated by evisceration. History for the only functional left eye includes previous anterior hypertensive uveitis, secondary glaucoma and traumatic cataract, and systemic history included psoriasis, type two diabetes, vertiginous syndrome, penicillin allergy and systemic hypertension. Presenting best visual acuity was 0.4 decimal 20/50 Snellen and clinical examination revealed a subluxated lens bag and traumatic nuclear and cortical lens opacification. IOP was 18mm Hg with two-times daily dorzolamide and timolol formula. After successful capsulorhexis and gentle facoemulsification we encountered significant zonular dehiscence during lens aspiration with zonules breaking upon lens mass aspiration and the bag folding around remaining lens masses. We managed to complete lens mass aspiration and unfold a weakened and subluxated lens bag. A 9.0 prolene suture with straight needle was passed was exterior-to-interior with the exterior end subsequently flanged. The free suture end was threaded extra-ocularly through the Cionni ring eyelet and the ring afterwards implanted. Final suture passage interior-exterior was aided by 30 Guage guide needle. A 1-piece monofocal IOL was implanted and the free suture end adjusted and flanged. Postoperative result was good (VA 20/20).

Compared to previous scleral-pocket Cionni suturing technique flanging instead of suturing could more gently distribute tension and thus be suitable for repositioning very weakened lens bags. This technique could be suitable for adults, however would be at a disadvantage to paediatric ectopia lentis patients where suture longevity is more some desired and thus suturing under scleral pocket advantaged.