Efficacy and safety of capsule support hooks vs. iris hooks in cataract surgery for cases with zonular insufficiency.

Objective: To compare the efficacy and safety of capsule support hooks and iris hooks in stabilizing the capsular bag during cataract surgery in patients with significant zonular weakness.

Methods: This retrospective comparative study included 46 eyes of 39 patients with zonular weakness exceeding 90 degrees who underwent cataract surgery at a tertiary clinic. Patients were divided into two groups due to intraoperative usage of capsule support hooks (Group 1) or iris hooks (Group 2) for capsular stabilization. Intraoperative complications such as capsular tears and vitreous loss, as well as postoperative visual outcomes and intraocular lens (IOL) centration, were evaluated.

Results: There was no significant difference in terms of postoperative visual acuity and intraocular pressures between the two groups (p = 0.370, p = 0.250 respectively). Anterior capsular tear occurred in 4 eyes in the iris hook group compared to none in the capsule support hook group (p = 0.017). Vitreous loss was observed in 4 eyes in the capsule hook group and 7 eyes in the iris hook group (p = 0.122). Cystoid macular edema developed in 1 patient in each group (p = 0.849).

Conclusions: Capsule support hooks provide a safer and more stable option for capsular stabilization for zonular weakness during cataract surgery with a lower incidence of intraoperative complications compared to iris hooks. Despite their higher cost and limited availability, capsule support hooks should be preferred to enhance surgical outcomes and patient safety. Iris hooks, while less optimal, remain a viable alternative when capsule support hooks are not available.