Back Where It Belongs: The Challenge Of Adjusting A Malpositioned Ctr During Cataract Surgery

This case highlights a challenging intraoperative scenario where significant zonular weakness (3 clock hours of dialysis) required Capsular Tension Ring (CTR) placement for the first time in my surgical career. The case became tricky when the CTR partially dislocated into the ciliary sulcus, causing iris traction instead of fully expanding in the capsular bag.

This case highlights a challenging intraoperative scenario where significant zonular weakness (3 clock hours of dialysis) required Capsular Tension Ring (CTR) placement for the first time in my surgical career. The case became tricky when the CTR partially dislocated into the ciliary sulcus, causing iris traction instead of fully expanding in the capsular bag.

A patient with a visually significant cataract underwent phacoemulsification, during which 3 clock hours of zonular dialysis were identified. A CTR was introduced, but its trailing end engaged the ciliary sulcus, causing iris traction. Using micro-instruments, it was successfully repositioned into the capsular bag.

The CTR restored capsular stability, and a posterior chamber IOL was implanted securely. Postoperative assessment showed a well-centered IOL and visual acuity improved to 20/25 at one month.

This case underscores the importance of anticipating and managing intraoperative complications in the presence of zonular weakness. Although initial CTR malposition created iris traction, careful recognition and prompt micro-instrument repositioning allowed successful stabilization of the capsular bag. Ultimately, the procedure resulted in a well-centered posterior chamber IOL and good postoperative visual recovery, reinforcing the value of vigilance,adaptability, and surgical skill when using a CTR for the first time.