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Tension Rings

A CTR is a 270 degree open PMMA ring placed in the capsular bag during cataract surgery in cases with zonular instability or weakness.

Aurolab manufactures 3 types of CTR,

capsular-tension rings

Product Features:

All types made from Clinical Quality UV absorbing PMMA, they are

  • Capsular tension rings (standard type)
    • For cases involving less than 4 clock hours (4 positions) of zonular dialysis, a standard CTR is suitable.
  • Cionni rings with single and double loop.
    • For cases involving greater than 4 clock hours or progressive zonular damage.
  • Capsular tension segment.
    • Partial ring used in cases that cannot be supported by CTR.

Indications:

  • Stabilization of the crystalline lens capsule in the presence of weak or absent zonules.
  • Pseudoexfoliation (lead to lens capsular damage, most common in glaucoma).
  • Prior trauma which leads to Zonulysis( damage of zonules) or capsular rupture.
  • Expected complications during phaco surgery.
  • Situations in which sudden unfolding of a foldable IOL might cause zonular breakage or dislocation of the IOL.
  • Repositioning of IOL decentration.
  • Marfan syndrome (results in subluxated lens with weak zonules).

Capsular Tension Ring (CTR):

ctr

 

  • CTR is an open-ended,
    • flexible horseshoe-shaped polymethyl methacrylate (PMMA) filament.
    • with two eyelets at either end.

Benefits:

  • It is used in cases involving less than 4 clock hours of zonular dialysis.
  • Ensures stable conditions during surgery.
  • Prevents capsular fibrosis.

Models:

Model No CTR 10 CTR 11
Overall Diameter 10.00 mm 11.00 mm
Closed Diameter 12.00 mm 13.00 mm

Cionni Rings:

cionni
  • In cases of profound zonulysis (i.e., greater than 4 clock hours) or extensive progressive zonular dialysis, a standard CTR may not provide adequate centration and stability.
  • In these case, a modified CTR designed by Cionni adds a comma-shaped filament attached to the main ring with an additional eyelet that allows it to be sutured to the scleral wall without piercing the capsular bag.
  • The eyelet is offset anteriorly to allow it to sit outside the capsular bag.
  • A double eyelet configuration is available for cases requiring additional support.

Cionni models:

cionni
  • Cionni with single right eyelet (CCR).
  • Cionni with single left eyelet (CCL).
  • Cionni with double right & left eyelet (CCLR).
Model No CC10L, CC10R, CC10LR CC11L, CC11R, CC11LR
Overall Diameter 12.00 mm 13.00 mm
Closed Diameter 10.00 mm 11.00 mm

Capsular Tension Segment:

cionni
  • This is a zonular support device that provides support for in-the bag implantation.
  • Its versatility enable early or late placement within the capsular bag.
  • It can be used in cases that cannot be supported by CTRs.
  • It is a partial ring with a fixation hook

Implantation:

  • CTR/ Cionni can be implanted manually or with the help of specially designed injector.
  • Requires presence of intact capsulorhexis and capsular bag.
  • Can be implanted at any step after capsulorhexis, but early placement makes cortical removal more difficult and tedious.
  • For these reasons, it is helpful to maintain multiple iris retractors at the capsulorhexis edge to stabilize the capsular bag during phacoemulsification and cortical removal.
  • After lens extraction, the iris retractors can be removed once the CTR has been safely implanted into the capsular bag prior to IOL insertion.

Advantages:

  • Circular expansion of capsular bags.
  • Stablizes conditions during surgery.
  • Improves IOL centration.
  • Reduces risk of capsular fibrosis.
  • Resists capsular shrinkage.
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