Comprehensive approach for capsular bag fixation in subluxated crystalline lens: Preserving the anterior/posterior anatomical segment barrier

Adi Porat Rein*, Adi Abulafia, Elishai Assayag, Mordechai Goldberg, David Zadok

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose:To report the intraoperative performance and postoperative outcomes of crystalline lens removal and in-the-bag intraocular lens (IOL) implantation with scleral-bag fixation by means of capsular tension segments (CTSs) and a capsular tension ring (CTR) in patients with a subluxated lens.Setting:Department of Ophthalmology, Shaare-Zedek Medical Center, Jerusalem, Israel.Design:Retrospective, consecutive case series.Methods:This study included patients with subluxated crystalline lens who underwent lensectomy or cataract extraction using an anterior chamber maintainer (ACM), a CTR, transscleral capsular-bag fixation by polytetrafluoroethylene suture with 2 CTSs, and in-the-bag IOL implantation. Outcome measures included intra- and postoperative complications, corrected distance visual acuity (CDVA), target and postoperative refraction, and IOL tilt.Results:17 eyes (9 patients) were included, with a mean follow-up of 22.06 ± 14.88 months. There was a significant improvement in mean logMAR CDVA (P <.001), with 15 eyes (88.24%) achieving a Snellen CDVA of 20/30 or better and all eyes achieving 20/40 or better. The mean refractive spherical-equivalent prediction error was 0.07 ± 1.10 diopters (D), with 10 (58.82%) and 15 (88.24%) of eyes within ±0.50 D and 1.00 D, respectively, from the intended refraction. The mean horizontal and vertical tilts were 1.9 ± 2.6 degrees and 2.6 ± 2.1 degrees, respectively. No complications were observed except for 1 case of an intraoperative posterior-capsular tear.Conclusions:A comprehensive surgical approach for scleral-bag fixation that combines the use of an ACM, CTR, polytetrafluoroethylene sutures, 2 CTSs with in-the-bag IOL implantation, offers an effective strategy for achieving favorable visual outcomes and a low incidence of complications in patients with subluxated crystalline lenses.

Original languageEnglish
Pages (from-to)1236-1241
Number of pages6
JournalJournal of Cataract and Refractive Surgery
Issue number12
StatePublished - 1 Dec 2023
Externally publishedYes


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