In certain populations, pseudo-exfoliation syndrome is relatively common, occurring in about 6 to 8% of my patients every year. In this condition, the fibrillar material that we see dispersed throughout the anterior segment of the eye leads to specific weaknesses. These include poor dilation, impedance to aqueous outflow, and progressive zonular instability. In some cases of zonular instability there is utility in using a capsular tension ring (CTR), but does it make sense to implant a CTR in all cases of pseudo-exfoliation? This is a complete cataract case shown start to finish with the only edit being cutting out about 1 minute of dead time while my scrub tech loaded the IOL. Do you recommend a CTR in all (or most) cases of pseudo-exfoliation? Please comment below.
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I am just thinking about PXF and prophylactic placement of a CTR, even if no zonular weakness detected intra op . We know they are going to be at higher risk in the future, the eyelet of a CTR ptentialy gives us something to fixate. But putting in a CTR *can* stress the zonules. Which is exactly why i like your 2 handed technique to hold the first eyelet in a sinskey hook until delivering the whole CTR . This prevents zonular stress 180 degrees away from the CTR as it goes in (if unsupported)