Subcortical Cortical Capsular Tension Ring Insertion: A Technique To Improve The Safety And Efficacy Of Cortex Removal In Case Of Zonular Instability
Published 2026 - 44th Congress of the ESCRS
Reference: POCAT269 | Type: Free paper | DOI: 10.82333/zf2r-jr60
Authors: Mr Maninder Bhogal* 1 , Dr Beatriz Vidal Villegas* 2
1Ophthalmology,St Thomas Hospital ,London,United Kingdom, 2Facultad de Medicina Universidad Complutense de Madrid ,Instituto de Investigaciones Oftalmológicas Ramón Castroviejo. ,Madrid,Spain
Purpose
To describe a novel technique to enhance the efficacy and safety of cortex removal and eliminate the additional zonular stress caused by removing cortex encarcerated behind a capsular tension ring (CTR). We describe the technique for sub-cortcal CTR implantation and present the resulst of 10 eyes of 10 patients.
Setting
Univeristy Hopsital Ophthalmic Surgical Theatre
Methods
A single thin strip of cortex in engaged 180 degree opposite the aspiration handpiece. As this is stripped centrally the irrigation handpiece is passed under the cortex. The irrigation cleaves the cortex from the poster capsular bag without zonular stress,keeping the capsular bag inflated. Cohesive OVD is used to fill the space between the posterior capsule and the cortical shell. The CTR can then be implanted under the cortex, avoiding cortical entrapment: Sub-cortical CTR Implantation. Success was measured by the ability to remove the cortex without visible movement or entrapment of the CTR, completeness of cortex removal and capsulorhexis centration prior to IOL implantation and IOL centration 1 week after surgery.
Results
In all 10 eyes complete cortex removal was possible. No movement of the CTR was observed during cortex removal and the capsulorhexis remained central following cortex removal in all cases. No cases of IOL decentration were observed on dilated examination at 1 week post-surgery
Conclusions
By positioning the CTR in a plane posterior to the cortical lens mater, the ring achieves full equatorial expansion without pinning cortical fibers. This maintains the mobility of the residual cortex, allowing for standard aspiration without the increased vacuum or mechanical traction typically associated with CTR placement when the cortex is trapped. Sub-cortical CTR implantation is a safe, reproducible and effective technique. It eliminates the additional zonular stress associated with cortex removal that can lead to incomplete cortex removal and IOL-CTR complex dislocation.