Advantages of the Cionni modified capsular tension ring with scleral fixation in large zonular dialysis

Background: Large traumatic zonular dialysis (larger than 140) induces significant surgical problems.

Methods: Two cases of large zonular dialysis with vitreous hernia in the anterior chamber, significant hypertonia, and cataract with subluxation of the lens are described. The surgical treatment consisted of ablation of the lens by phacoemulsification after anterior capsular rhexis and insertion of a conventional capsular tension ring. Then a Cionni ring was sutured to the sclera opposite the center of the zonular dialysis zone. The implant was inserted in the bag followed by an anterior vitrectomy. The IOL was centered in a stabilized bag in both patients. Postoperative visual acuity was excellent, with transitory hypertonia controlled with medical treatment.

Conclusions: The conventional capsular tension ring does not allow effective treatment of large zonular dialysis or recentration of the bag. However, the Cionni modified ring stabilizes and recenters the bag, allowing capsular preservation and implantation in the bag. The authors describe the insertion technique for this type of ring. Conclusions: The Cionni ring seems to provide an effective surgical solution to large traumatic zonular dialysis with subluxation of the lens. However, the insertion technique for the ring is difficult to perform.