Surgical Management Of Traumatic Subluxation Of Lens With Cyclodialysis: A Two-Case Series

Purpose: To describe a surgical management of traumatic subluxation of lens with cyclodialysis using a standard capsular tension ring (CTR)

Due to registration certificate issues, devices such as the m-CTR, capsular tension segment (CTS), and Assia Anchor are currently unavailable in many countries. Therefore, how to make the most of the common auxiliary tools such as standard CTR in moderate and severe subluxation to retain the capsular bag requires ophthalmologists to continue exploring.

Case 1: A 40-year-old male had left ocular trauma from a grinding wheel fragment a month ago. BCVA was FC/30 cm,  IOP 8.7 mmHg. Slit-lamp：uneven anterior chamber depth, absent peripheral anterior chamber  (superior - temporal), dilated pupil, supero - temporal iris posterior synechia, lens tremor (C4N2P4 opacity), and zonular dehiscence in the superotemporal quadrant. Fundoscopy：optic disc and retinal edema. UBM: cyclodialysis. Diagnoses: traumatic lens subluxation, cataract, cyclodialysis, retinal contusion. The patient underwent left-eye Phaco with intrascleral fixation of a standard CTR within lens capsule using the modified knotless Z-suture technique, IOL implantation, ciliary sulcus cryotherapy , and anterior vitrectomy under local anesthesia. Case 2: A 13-year-old female had right - eye trauma from a firecracker explosion 3 months ago. Previously diagnosed with "cyclodialysis in the right eye" at a local hospital and underwent "ciliary body suturing with anterior chamber reconstruction." BCVA  was 0.15,  IOP 9.0 mmHg. Slit-lamp：subconjunctival sutures in place, vitreous herniation into the anterior chamber, lens tremor (C3N2P5 opacity). UBM: cyclodialysis. Diagnoses: traumatic lens subluxation, cataract, cyclodialysis. She underwent right-eye Phaco with intrascleral fixation of a standard CTR withing lens capsule using the modified knotless Z-suture technique, IOL implantation, CTR indentation of the ciliary sulcus and anterior vitrectomy under general anesthesia.

Conclusion: Traumatic subluxation of lens is often accompanied by cyclodialysis. Due to registration certificate issues, devices such as the m-CTR, capsular tension segment (CTS), and Assia Anchor are currently unavailable in many countries. Intrascleral fixation of a standard CTR within lens capsule provides a safe and effective method for managing moderate-to-severe lens subluxation, while also providing partial effect of internal  ciliary body suture. Additionally, to enhance the healing rate of cyclodialysis, personalized combinations of cyclocryotherapy and CTR-mediated ciliary sulcus internal compression may be employed to achieve optimal outcomes with minimal trauma.