The Lord of the Rings – Difficulties and Complications of Capsular Tension Rings with Fixation Eyelets

     Purpose: The capsular tension rings with fixation eyelets (or rings of Cionni) are the most suitable and also more and more used in small incision surgery of the great subluxations of the crystalline lens.

     The authors present several types of surgical approach for the implantation of this type of rings, show the intra-operative difficulties and describe the new postoperative complications created by this surgical technique.

     Material and methods: The authors present 5 cases of subluxation of the crystalline lens in which they used different surgical approaches, based on the scleral fixation of the capsular tension ring, in order to allow phacoemulsification and insertion of the intraocular lens with a small incision.

     They show the intra-operative difficulties, namely the modified capsulorrexis technicque in this type of cases as well as the techniques of scleral fixation.

     The authors also show the postoperative complications, e.g. posterior capsule opacification and posterior capsulotomy, and the subluxation of the IOL when it was not properly placed in the capsular bag.

     Results: In spite of the inherent difficulties of this surgical technique and in spite of the recognition of the possible new complications, we still think that the preservation of the capsular bag should be the basis of the surgical attitude in the resolution of this type of cases, fact confirmed by the good anatomic and functional results obtained.