Scleral fixation of a capsular tension ring for severe ectopia lentis

A 4-year-old boy with bilateral idiopathic and progressive ectopia lentis h ad phacoaspiration of the lens and capsular tension ring (CTR) insertion in his left eye. Postoperatively, lens capsule centration remained poor. Sing le-point scleral fixation of the CTR was performed and centration of the le ns capsule achieved in-the-capsule intraocular lens (IOL) implantation was tried, but excessive IOL manipulation sliced open the capsule at the equato r. Anterior vitrectomy and scleral IOL fixation were required. A similar ap proach was adopted in the right eye with meticulous attention given to gent le maneuvers. The operation was uneventful, with good IOL centration. Three and 11 months after surgery in the right and left eye, respectively, best corrected visual acuity was 20/50 in both eyes. Scleral fixation of the CTR , accompanied by gentle IOL manipulation, is an option to improve IOL centr ation in patients with severe zonular deficiency. J Cataract Refract Surg 2 000; 26:609-612 (C) 2000 ASCRS and ESCRS.