Zonular compromise: A narrative review of indicators and management strategies

The reported prevalence of zonular weakness in the general population ranges between 0.46% and 2.6%. Several etiological risk factors are associated with zonular weakness, including increased age, pseudoexfoliation syndrome, Marfan syndrome, homocystinuria, retinitis pigmentosa mature cataracts, high axial myopia, and previous ocular trauma or surgery. Careful preoperative assessment or intraoperative recognition of the condition in the early steps of cataract surgery can aid in the prevention of complications and facilitate the management of the case. In this article, we summarized the available evidence to improve the surgery outcome and prevent complications. We mainly explored different approaches and instrumentation to preserve the lenticular capsule and aid in-the-bag intraocular lens implantation.