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Congatulations, for the wonderful surgical treatise.May be after such a nice placement of Cionni's ring endocapsular placement of IOLwould have been a better option.

Scleral suturing of a PC IOL would be an alternative if the capsule had been torn/lost. The CTR reinforced capsular bag has enough zonular support for a PC IOL placed in the sulcus. The reason for the Cionni ring fixation is because the entire bag-complex wanted to tilt forward, and I was afraid that it would prolapse through the pupil, or might tip into the back of the iris. Remember, the crystalline lens was prolapsing into the AC.

Congratulations. Scleral sutured IOL wouldn`t have been an alternative? If the answer is no, why? Thanks

בהחלט מעניין, אם יש לך זמן.

I have a total of 20 eyes with microspherophakia all of them were done with 10-12 mm CTR without scleral suturing except in one where the zonules were to weak to accept insertion of CTR. Some had follow up to 9 years. Data was presented at AAO last year. In many of these cases CTR 10-12 (or even smaller that can be custom made)are adequate without Cionni type insertion. This year will presented as a video at the AAO if it is accepted.

Good question. The zonules were so lax that the capsular bag was not expanded except for the capsule retractors. One challenge with CTRs in these cases is that process of insertion will decenter the bag enough to shear loose the few remaining zonules. Therefore, I placed a std CTR while I still had the supporting hooks in place to expand the bag open. Without this, I would not have been able to get the Cionni ring in as atraumatically. With the external eyelet, it is difficult to insert the Cionni ring with capsular retractors in place. The IOL dioptric power was quite normal, as she had a normal axial length, despite a preop spectacle correction of -18 D.

Why did you put 2 CTR in the bag? Was it better to put just Cioni ring in the bag?

congragulations, what are the diopries of IOLs?

whew! chang rules.