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Traumatic Zonular Dehiscence - A Case for Cionni Ring

Alin Stefanescu-Dima, MD, PhD

Dr. Alin Stefanescu-Dima, MD, PhD, shares the case of a patient with no light perception in his left eye after open globe trauma during childhood, hand movement vision in his right eye after blunt trauma with progressive lens opacification 2 years earlier. The 32-year-old caucasian male has a white cataract, zonular dialysis expanding over more than 180 degrees, mydriasis following sphincter ruptures and posterior synechia are present in the right eye. After staining the anterior capsule under an air bubble, vitreous is blocked using dispersive viscoelastic and anterior capsulorhexis is initiated. Counterforce is provided by iris hooks anchored on the anterior capsule margin as the capsular tear progresses through the zonular deficient area. Viscodissection is used to mobilize the soft lens material which is then evacuated by means of dry aspiration and automated irrigation/aspiration. The lens bag is stabilized and centered using a right hand as a single eyelet Cionni capsular tension ring is secured with a double-armed polypropylene suture. A foldable three piece IOL is inserted in the sulcus, as this position is judged to offer a better long-term stability. Visual recovery is excellent, with a 20/20 BCVA postoperative day 7.

Posted: 11/05/2012