Management of the subluxated crystalline lens mainly depends on the amount of zonular loss in the eye. In cases of severe zonular dialysis, the entire lens is usually removed, and either an IOL is implanted in the anterior chamber or a posterior chamber lens is fixated to the sclera or iris. In mild to moderate cases, a capsular tension ring (CTR) or a modified CTR such as the Cionni Modified CTR (Morcher GmbH, Stuttgart, Germany) or the Ahmed Capsular Tension Segment (Morcher GmbH) may be used for fixation of the capsule to the scleral wall.
The Capsular Anchor (Hanita Lenses, Kibbutz Hanita, Israel) is a novel device designed for scleral fixation of the preserved capsular bag of subluxated lenses. This anchor may be used in cases of moderate to severe zonular loss.
The PMMA clip-like intraocular implant has a central rod that is placed in front of the capsule and two lateral arms, inserted through the capsulorrhexis, are positioned behind the anterior capsule. A hole in its base can be used for a temporary safety suture, and a second distal hole is used for threading the fixation suture (10-0 or 9-0 Prolene [Ethicon, Inc., Somerville, New Jersey]). Alternatively, the suture may be simply wrapped around the central rod (Figure 1). A CTR can be inserted for additional capsular stabilization, either before or after insertion of the Capsular Anchor. Unlike modified CTRs, which come in contact only with the capsular equator, the Capsular Anchor has tight contact with a large area of the anterior capsule.
Recently, we implanted the Capsular Anchor in four eyes (4 patients) with cataractous subluxated lenses and zonular loss around 4 to 6 clock hours. Our first case was a 29-year-old man with a traumatic cataract and upward subluxation of the lens. After a central capsulorrhexis and anterior vitrectomy, the anchor was implanted and secured to the scleral wall with a10-0 Prolene suture at the 5-o'clock position. Stable lens fixation facilitated removal of the lens material with phacoemulsification. A CTR and an AcrySof three-piece IOL (Alcon Laboratories, Inc., Fort Worth, Texas) were implanted in the capsular bag. The patient's preoperative UCVA (20/80) improved to 20/30 after surgery. At 12-month follow-up, the lens was central and stable.
In the next two cases, we implanted the Capsular Anchor in patients with lens subluxation due to Marfan syndrome. In a 57-year-old woman with cataract and upward subluxation of the lens, an anchor was placed inferiorly. During surgery, extension of the zonular dialysis was detected supero-temporally, and a second anchor was inserted. A CTR and an IOL were then implanted. Her BCVA improved from 20/40 preoperatively to 20/25 postoperatively. In the third case, we placed the anchor at the 6-o'clock position but did not use a CTR (Figure 2). BCVA improved from 20/200 preoperatively to 20/20 postoperatively.
In the final case, we treated a 73-year-old man with superotemporal zonular dialysis following a blunt injury that occurred 33 years ago. The patient presented with recent visual deterioration due to cataract. His UCVA was 20/200. Macular hard druzen and nonproliferative diabetic retinopathy were also observed. An anchor was placed at the 11-o'clock position (Figure 3). Two months after surgery, his BCVA was 20/50. Optical coherence tomography confirmed the presence of cystoid macular edema. We treated the patient with diclofenac topical, and the edema regressed.
In summary, the novel Capsular Anchor device is an alternative to restore centration and stability of the capsular bag of subluxated lenses. Implantation of the anchor prior to lens removal facilitates phacoemulsification because the lens is central, stable, and secured to the scleral wall. The anchor is relatively easy to implant, and a CTR may also be used to restore the round contour of the capsular bag and maintain even tension over the lens equator. Further clinical experience is required to prove the safety and efficacy of the Capsular Anchor.
Ehud Assia, MD, is the Chairman of the Department of Ophthalmology, Meir Medical Center, Kfar-Saba, Israel, and the Medical Director, Ein-Tal Eye Center, Tel-Aviv, Israel. Professor Assia states that he is a paid consultant to and has a royalty agreement with Hanita Lenses. He is the inventor of the Capsular Anchor. He may be reached at assia@netvision.net.il.
Adi Michaeli, MD, is a senior physician at the Ein-Tal Eye Center, Tel-Aviv, Israel, and the Head of the Cataract Service, Soraski Medical Center, Tel-Aviv, Israel. Dr. Michaeli states that she has no financial interest in the products or companies mentioned. She may be reached at michaeli.adi@gmail.com.
Yokrat Ton, MD, is a senior physician in the Meir Medical Center, Kfar-Saba, Israel, and a physician at the Ein-Tal Eye Center, Tel-Aviv, Israel. Dr. Ton states that she has no financial interest in the products or companies mentioned. She may be reached at barakton@013.net.il.
