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Terry Kim, MD Professor of Ophthalmology
Duke University School of Medicine Cornea and Refractive Surgery Services
Duke University Eye Center
Kiawah Eye 2013
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Consultant - Alcon - Bausch & Lomb - Ivantis - Ocular Systems Inc. - Ocular Therapeutix - Omerus - Powervision - SARcode Bioscience
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61 y/o healthy female patient comes for evaluation of chronic progressive bilateral vision loss ◦ VA CC OD 20/60 OS 20/40 ◦ SLE remarkable for bilateral NS and PSC cataracts
with mild superior lens subluxation and inferior zonular deficiency. No phacodonesis
Patient denies any history of ocular trauma, or previous eye surgery.
Only oral medication is baby aspirin 81 mg
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Iris Hooks Capsule Retractors
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Modified CTR (M-CTR)
Capsular Tension Segment (CTS)
Expansion of capsular equator Buttress areas of weak zonules Recruit and redistribute tension from existing zonules Recenter a mildly subluxed capsular bag
Capsular Tension Ring (CTR)
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Minimal 0-2 clock hours of dialysis
Minimal phacodonesis Haptics in area of dialysis Cautious phaco +/-CTR
Mild <4 clock hours of dialysis
Mild phacodonesis, Ovalization of rhexis
CTR (+/- iris or capsule retractor)
Moderate 4-8 clock hours of dialysis
Moderate phacodonesis, Overt decentration Capsular collapse
M-CTR or CTS (+ iris or capsule retractor)
Severe >8 clock hours of dialysis
Severe phacodonesis M-CTR with double islets (+ retractors) Multiple CTS Suture fixated IOL AC IOL
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MST Capsule Retractor Alcon ReFORM CTR
Images shown for educational purposes only
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Pt very happy with visual results ◦ VA sc OD 20/25 OS 20/20
SLE: well-centered single-piece PCIOL
No pseudophacodonesis