Ab externo scleral fixation of the Cionni modified capsular tension ring

The Cionni modified capsular tension ring (CTR) allows for scleral fixation in cases of significant zonular dialysis, providing long-term centration of in-the-bag foldable intraocular lenses. Previous techniques of suture placement require placement of the primary incision along the axis of zonular weakness or enlarging and/or distorting the primary incision to attain proper positioning. They also use blind passes of the needle under the iris to approximate the ciliary sulcus. We describe an external closed-system approach for preplacing 10-0 polypropylene sutures in the ciliary sulcus for a Cionni modified CTR under topical anesthesia. This technique does not use blind passes of the suture needle and results in accurate placement of the sutures in the ciliary sulcus under a closed and stable system.