title: Surgical repositioning of dislocated capsular tension rings.
abstract: OBJECTIVE
  To present techniques and results of surgical repositioning of subluxed and dislocated capsular tension rings (CTRs).
  
  
  METHODS
  Retrospective interventional case series.
  
  
  METHODS
  Eleven patients with a previously implanted CTR in-the-bag for zonular weakness who presented with CTR-intraocular lens (IOL)-capsular bag decentration who underwent surgical repositioning.
  
  
  METHODS
  Data from 11 patients who underwent surgical repositioning were evaluated retrospectively for underlying diagnosis, interval between initial surgery and decentration, surgical technique, clinical results, and complications.
  
  
  METHODS
  Capsular tension ring-IOL-capsular bag centration, final best-corrected visual acuity (BCVA), and surgical complications.
  
  
  RESULTS
  Of the 11 patients with CTR decentration, 3 had it early in the postoperative period, and 8 had it late. Mean (+/- standard deviation) durations from cataract extraction and CTR implantation to surgical repositioning were 6.1+/-7.9 months for those with decentration early and 49.6+/-15.3 months for late decentrations (overall range, 0.7-74.7). Of the 11 patients, 7 had pseudoexfoliation, and 4 of the 7 had associated glaucoma. Nine patients had subluxation of the CTR-IOL-capsular bag complex, which was managed by an anterior segment approach. A pars plana vitrectomy and levitation of the CTR was required in 2 patients due to complete dislocation of the CTR into the posterior vitreous. Surgical techniques for repositioning included single, double, or 3-point scleral suture loop fixation of the CTR through the capsular bag complex (8 eyes); use of the capsular tension segment (CTS) placed within the capsular bag for scleral suture fixation (2); or iris suture fixation of the IOL haptics (1). All patients achieved successful anatomical repositioning of the CTR-IOL-capsular bag complex. Mean preoperative BCVA improved from 20/100 to 20/40 postoperatively. After repositioning surgery, BCVA improved in 7 patients, was maintained in 2, and worsened in 2 (due to advanced glaucoma).
  
  
  CONCLUSIONS
  Postoperative CTR subluxation or dislocation is a risk for patients with severe or progressive zonulopathy. Decentrations may be effectively managed with scleral suture fixation of the CTR through the capsular bag or the use of the CTS.
authors.affiliation: University of Toronto, Toronto, Canada. ike.ahmed@utoronto.ca
authors.forename: Iqbal Ike K
authors.initials: II
authors.lastname: Ahmed
authors.forename: Sylvia H
authors.initials: SH
authors.lastname: Chen
authors.forename: Christoph
authors.initials: C
authors.lastname: Kranemann
authors.forename: David T
authors.initials: DT
authors.lastname: Wong
mesh_terms: D000368:Aged; D002387:Cataract Extraction / Q000295:instrumentation*; D005260:Female; D005548:Foreign-Body Migration / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D007903:Lens Capsule, Crystalline / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D019736:Prostheses and Implants; D012086:Reoperation; D012189:Retrospective Studies; D013536:Suture Techniques; D014792:Visual Acuity; D014821:Vitrectomy