To fixate a Cionni Modified Capsular Tension Ring, we must anchor the eyelet to the sclera, typically 1.5 to 2.0 mm posterior to the limbus, to provide permanent centration of the capsular bag. When utilizing 7-0 Prolene it can be tied in a knot but some surgeons now favor a flanged approach where the suture is externalized and cauterized into a bulb, providing a low-profile anchor. Alternatively, 8-0 Gore-Tex is highly regarded for its exceptional tensile strength and long-term stability, as it does not undergo the same hydrolytic degradation as Prolene. However, Gore-Tex requires larger sclerostomies and must be tied in a loop, necessitating a reliable method for knot burial to prevent extrusion.Choosing between a scleral flap and a Hoffman pocket involves weighing conjunctival preservation against surgical ease. The traditional scleral flap requires a peritomy and a lamellar dissection to cover the suture knot, which can lead to localized scarring and potential flap atrophy over time. In contrast, the Hoffman pocket is a conjunctival-sparing technique where a lamellar pocket is dissected posteriorly from a clear corneal incision. While technically more demanding to navigate, the Hoffman pocket eliminates the need for a peritomy and provides a secure, internal space to bury the knot, significantly reducing the risk of postoperative suture erosion and patient discomfort.
