Capsule retractors for intraoperative stabilization of the lens during phacoemulsification with weak zonules: a retrospective review

Purpose To examine the outcomes of phacoemulsification with capsule retractors in eyes with severe zonular weakness in terms of postoperative stability of the intraocular lens (IOL) and complications. Methods All cataract surgeries utilizing capsule retractors in a specialized eye clinic over 6 years were retrospectively reviewed. Predisposing risk factors, the intraoperative technique, the visual acuity, the refractive outcome and position of the IOL were analyzed. Results Forty-four surgeries were identified. Postoperative data was available in 36 cases (81.8%) for a mean observation period of 18.3 ± 18.8 months. In 42 cases (95.5%) the surgery was completed with implantation of a capsular tension ring (CTR) and an IOL in the capsular bag. The mean refractive prediction error was 0.04 ± 1.10 D. The mean astigmatism was reduced from − 1.85 ± 1.27 D to -1.52 ± 0.80 D ( P  = .09). In 15 eyes the IOL was centered and in 10 eyes slightly decentered, in all cases the IOL covered the optical axis. Postoperatively one (2.3%) late dislocation of the IOL and one (2.3%) retinal detachment occurred. Conclusions Capsule retractors combined with a CTR are safe and effective for the management of cataract with compromised zonules. The postoperative IOL position and refraction show little clinically significant decentration.