Scleral Fixation Of A Modified Cionni Capsular Tension Ring With The “Loop-Flange Technique” In Ectopia Lentis Cases

To evaluate the efficacy and safety of scleral fixation of the capsular bag using a modified Cionni capsular tension ring (MCTR) with a knotless 6-0 polypropylene “loop-flange” technique in ectopia lentis eyes with extensive zonular dialysis (>180°).

Single-center, retrospective case series.

Sixteen eyes of 12 patients with ectopia lentis secondary to trauma or genetic disorders (Marfan syndrome or homocystinuria). The capsular bag was stabilized with iris retractors, and lens aspiration/phacoemulsification was completed.A needleless 6-0 polypropylene suture was passed through the MCTR eyelet to create a “loop,” and the ring was implanted into the capsular bag.Two scleral fixation points were marked 2.0 mm posterior to the limbus and aligned with the center of the zonular defect.Using a 30-gauge needle with lamellar scleral passage, both suture ends were externalized, flanged with cautery for knotless fixation, and an in-the-bag IOL was implanted.Outcomes included best-corrected visual acuity, IOL centration, and complications.

Mean follow-up was 13.35±9.42 months. Mean best-corrected visual acuity improved significantly from 1.04±0.60 to 0.25±0.47 logMAR (p<0.001). IOLs were well-centered in the majority of eyes; one eye developed postoperative IOL decentration requiring reoperation. No other major intraoperative or postoperative complications, such as retinal detachment or secondary glaucoma, were observed during the follow-up period.

In ectopia lentis with >180° zonular dialysis, knotless scleral fixation of an MCTR using a 6-0 polypropylene loop-flange technique may provide effective capsular bag and in-the-bag IOL stabilization with favorable visual outcomes. This approach may offer potential long-term advantages, particularly in pediatric patients, by avoiding knot-related issues and reducing concerns associated with late suture failure.