This is a very tough case because of the prior trauma which has resulted in severe zonular loss and a scarred, fibrotic lens capsule. Even from the title picture we can tell that there is at least 180 degrees (6 clock hours) of zonular loss with the lens nucleus displaced. How will you remove the cataract and will implanting a CTR (capsular tension ring) be enough?
A capsular tension ring (CTR) is designed to stabilize the capsular bag in cases of zonular weakness or partial zonular dialysis, but its effectiveness depends on the extent of zonular loss. Generally, a CTR can adequately support up to approximately 3 to 4 clock hours of zonular deficiency, or about 90 to 120 degrees. In cases where zonular loss is mild to moderate, the CTR redistributes forces around the capsular equator, maintaining its contour and facilitating safe phacoemulsification and intraocular lens implantation. However, when zonular loss exceeds 4 clock hours, additional support such as a modified CTR with fixation elements (Cionni ring) or capsular tension segments (Ahmed segments) may be necessary to prevent capsular instability or IOL dislocation. In this case, what would you recommend?
