Reply: Loop-on-suture-guided insertion for easier capsular tension ring insertion and residual cortex removal
Abstract
hank you for the reminder of your technique of filament manipulation with the capsular tension ring (CTR). CTRs are inserted mostly in cases of damaged zonula and potentially affected capsular bag.
During standard implantation, the remaining zonular fibers are stressed. Moreover, the leading eyelet, inserted without visual control, can penetrate the affected lens equator.
CTR eyelet guidance minimizes both the zonular tension and the risk for capsular damage. Advantage of using the filament over the other eyelet leading methods, for example, with the hook, is that the filament can be kept until the end of the surgery.
This eliminates the risk for the CTR disappearing in the vitreous cavity during complicated continuation of the surgery. For these reasons, we think surgeons should adopt the filament suspension method for any risky CTR implantation.
The choice of suspension technique would depend on their surgery preferences. Our technique is based on the Page one eyelet leading method.
In our technique, we tried to replace tweezers with a simpler instrument. The large loop enables Kuglen hook manipulation.
That there is only one knot may be an advantage over your method. We appreciate the advantages of your technique: the safer bidirectional CTR movement and the secured insertion of the trailing eyelet.
However, the biggest difference is in the extraction of the residual cortex retained by the ring. This can be facilitated by rotating and centripetal pulling of the ring during irrigation/aspiration.
Manipulating the filaments with tweezers enables simultaneous coaxial irrigation/aspiration only. Our large loop can be led by an irrigating manipulator, so the bimanual irrigation/aspiration can be performed.