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Home Clinical Education Cataracts ASCRS Focus on Cataract Surgery July 2020
ASCRS Clinical Education

ASCRS Focus on Cataract Surgery

Capsular Support: Rings, Hooks, and More

July 2020

Zonular weakness can be a cause for concern in cataract surgery, increasing the risk of complications such as lens dislocation and posterior capsule rupture. In order to avoid such complications, capsular support devices can be used to improve capsular bag stability and centration. 

In this month's ASCRS Focus on Cataract Surgery, explore educational resources about the variety of capsular support devices available to today's cataract surgeon.

Capsular Tension Rings

Use the arrows below to browse and view a selection of videos covering the basics and usage of capsular tension rings.

Presentation
Capsular Tension Ring Pearls
Zachary J. Zavodni, MD 09:12 minutes
May 2019
Video
The Use of a Pupil Expansion Device to Stabilize the Capsule and Allow Phacoemulsification in a Patient with Severe Zonulopathy
James Lehmann, MD 03:58 minutes
May 2020
Video
Usefulness of Sulcus-Fixation of Standard Capsular Tension Ring in the Capsular Instability during Cataract Surgery
Hoseok Chung, MD; Kyu Sang Eah, MD; Chan Yun Kim, MD, PhD; Jae Yong Kim, MD, PhD; Moses Kim, MD; Chang Mok Lee, MD; Hungwon Tchah, MD, PhD 06:25 minutes
May 2020
Presentation
Capsular Stabilization: Tips and Tools
Sumitra S. Khandelwal, MD 08:02 minutes
May 2019
Video
Malyugin Chronicles: The Curse of the Ring
Ranjan Dutta, MBBS, MD; Rushad Shroff, MD 05:35 minutes
May 2020
Video
New Small-Pupil Expansion Device with Not-Aligned Indents
Sergio Canabrava, MD, Leonardo C. Gontijo, MD, Ana Elisa L. Arancibia, MD, Luiza Filgueras Bicalho Dornelas, MD, Carolina S. Freitas, MD, Guilherme B. Ribeiro, MD 08:00 minutes
April 2018
Video
Hook–CTR for Easier Transscleral Fixation in Weak Zonule Cases
Tsukasa Hanemoto, MD 07:31 minutes
April 2018
Video
Goldilocks and Right-Sized Rings
Bo Li, MD, FRCSC, Michael Snyder, MD 07:51 minutes
April 2018
Video
A Critical Analysis of CTR Insertion and a Novel Injection System to Reduce CTR Complications
Producer: Timothy Page, MD 08:00 minutes
May 2019
Video
Use of a Hinged Pupil Expansion Device to Enable FLACS through Small Pupils
Producer: Harvey Uy, MD 07:49 minutes
May 2019
Video
Dislocated Cionni IL & CTS Toric IOL
Soon-Phaik Chee, FRCSEd, FRCOphth 01:57 minutes
May 2019
Presentation
Management of Subluxated Lenses
Jorge L. Domene Sr., MD 10:09 minutes
May 2019

EyeWorld Article

Placing hooks, rings, and things

By Maxine Lipner Senior Contributing Writer
Hooks and expansion rings can be an ophthalmologist’s partner when performing phacoemulsification.

Douglas Koch, MD, relies on pupillary expansion devices when there’s a risk of inadequate visualization or the potential for iris trauma (via accidental engagement with the phaco tip or through some other manipulation)...

Read more on EyeWorld.org >>

EyeWorld Article

Presentation spotlight: Expanding the iris needs to be safe and easy

By Stefanie Petrou Binder, MD, EyeWorld Contributing Writer
Iris expanders are commonly and gratefully implemented by cataract surgeons in eyes with small pupils. Enlarging the pupil makes cataract surgery safer and easier. It allows the surgeon improved visualization that facilitates anterior capsulorhexis performance, lens removal, and IOL implantation...

Read more on EyeWorld.org >>

Optimize Your Use of Capsular Support Hooks

Presentation
Complex Case Pearls: Versatility of Iris Hooks in Complex Cataract Cases
Ernesto J. Otero, MD 07:39 minutes
May 2019
Video
Captain Hook's Nightmares: Iris Hook Complications and Prevention
Producer: Ahmet Akman, MD , FACS 07:55 minutes
May 2019
Presentation
Saving the Unstable Lens with Capsular Support Hooks
Guy Kleinmann, MD 10:32 minutes
May 2019
Presentation
Bitten Twice, Emerged Victorious
Debashis Dutta, MS 08:41 minutes
May 2019

Small Pupil Management

Presented by Naveen K. Rao, MD, ABO

This presentation covers the many techniques for management of small pupils during cataract surgery. Optimal techniques for inserting and removing iris hooks and Malyugin rings are discussed.

Cataract Cases: Hooks & Rings

Explore these case-based surgical videos including the use of various capsular support devices.

Presentation
Case 5: Malyugin Ring X-change
Boris E. Malyugin, MD, PhD 08:55 minutes
May 2019
Presentation
Case 12: Mature Ultra-Brunescent Lens with Small Pupil
David F. Chang, MD 08:11 minutes
May 2019
Presentation
Hypermature Cataract
Sumitra S. Khandelwal, MD 08:05 minutes
May 2019
Presentation
Case 10: IOL Repositioning
Robert J. Cionni, MD 07:46 minutes
May 2019
Presentation
Bitten Twice, Emerged Victorious
Debashis Dutta, MS 08:41 minutes
May 2019
Video
Three Inferior Zonules, 2 Hazy Media, and 1 Big Gap Repair
Linnette Arzeno, MD, Nassim Abreu, MD 04:40 minutes
April 2018
Video
Capsulotomy Creation Using Nano-Pulse Technique in a Case of Microspherophakia with Weak Zonules Followed By In-the-Bag IOL Fixation
Producers; Nizar Din, MBBS, FRCOphth ; Marwan Ghabra, FRCSEd 07:23 minutes
May 2019

JCRS Article

Loop-on-suture-guided insertion for easier capsular tension ring insertion and easier residual cortex removal

Journal of Cataract & Refractive Surgery: June 09, 2020 - Volume Publish Ahead of Print - Issue -
doi: 10.1097/j.jcrs.0000000000000276

The capsular tension ring (CTR) is a useful aid in cataract surgery involving zonular impairment. In standard implantation with tweezers or injectors there is limited control of the leading eyelet...

Read more on the JCRS Website >>

JCRS Article

Iris hooks versus a pupil expansion ring: Operating times, complications, and visual acuity outcomes in small pupil cases

Journal of Cataract & Refractive Surgery: February 2019 - Volume 45 - Issue 2 - p 167-173
doi: 10.1016/j.jcrs.2018.08.038

Purpose: To compare iris hooks and a pupil expansion ring (Malyugin ring) in eyes with a small pupil.

Read more on the JCRS Website >>

Medical and surgical management of the small pupil during cataract surgery

ASCRS Clinical Committee Report

Authored by the ASCRS Refractive Cataract Surgery Subcommittee
As cataract surgery continues to evolve, the intraoperative small pupil continues to pose challenges to even the most experienced cataract surgeon. Several steps can be taken preoperatively to decrease the chance of intraoperative miosis. Even so, the problem of miosis during cataract surgery remains a relatively common occurrence....

Read Full Clinical Report
Enjoyed this Focus on Cataract Surgery?
View the full list of topics available in the Focus on Cataract Surgery homepage.
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