3109: subluxed cataract after trauma
Managing a traumatic subluxed cataract with greater than 180 degrees of zonular loss requires a systematic intraoperative strategy to secure the capsular bag and protect the anterior segment. Intracameral injection of a small amount of dilute triamcinolone acetonide serves as the crucial first step, immediately highlighting prolapsed vitreous that must be cleared via anterior vitrectomy before commencing lens manipulation. Temporary placement of hooks or retractors then recenters and stabilizes the unstable capsular bag during phacoemulsification and cortex removal. To establish permanent structural containment and centration, a Cionni capsular tension ring with a modified eyelet is inserted and sutured directly to the sclera, reinforcing the deficient zonular apparatus for safe, long-term IOL fixation. Watch the video to see how triamcinolone visualization, temporary hooks, and a scleral-sutured Cionni ring enable successful reconstruction in severe traumatic zonulopathy. What intraoperative steps or devices do you prioritize when confronting extensive traumatic zonular dialysis? Please comment your thoughts below.
