Zonuloplasty, a novel surgical treatment for zonular weakness in patients undergoing cataract surgery

Patients with zonular weakness, undergoing cataract surgery, have a very high risk of the Intraocular Lens (IOL) dislocation during this operation. Strengthening the capsular bag is undeniably important in these patients. In this article, we suggest a novel surgical technique as a prospective treatment for zonular weakness in such patients. A triangular capsular flap is cut from the anterior capsule with the base directed towards the zonular break area. Basal peripheral iridotomy (PI) is performed in the same zone through corneal paracentesis. The tip of the capsular flap is caught with capsular forcept which is guided through both PI and corneal paracentesis. The tip of the flap is fixed in corneal stroma with a full thickness 10/O suture. After the lens implantation, the triangular anterior capsular flap is sutured in PIat iris edges and residues of flap in the anterior chamber are cut along the iris plane. Sutures from cornea along with the cut part of the flap are removed. This technique may be more practical in ECCE but it is very difficult to perform in Phacoemulsification. In this condition, a very tiny iris clip can be used instead of suturing to grasp the capsular flap in PI site and suspend it from the iris. This flap prevents dislocation of bag contents into vitreous and the possibility of vitreous loss through zonular defect and is a reliable support for PC/IOL. We can perform zonuloplasty in one quadrant zonal defect or 2-4 quadrants in the cases like Marfan Syndrome. Zonuloplasty is an innovative surgical procedure in cases with zonular instability more than 1/4 quadrant when CTR is ineffective.