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Three-flanged capsular hook for zonular dialysis repair.

Anjali Khadia1, Swati Upadhyaya2, Rengaraj Venkatesh2

  • 1Pediatric Opthhalmology Services, Aravind Eye Hospital, Pondicherry, India.

Indian Journal of Ophthalmology
|January 7, 2026
PubMed
Summary

A novel three-flanged Prolene suture technique effectively manages zonular dialysis during cataract surgery. This method ensures intraocular lens stability in patients with preoperative zonular deficiency, improving surgical outcomes.

Keywords:
Capsular tension ringcataract surgeryintraocular lens implantationthree-flanged capsular hookszonular dialysis

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Area of Science:

  • Ophthalmology
  • Surgical Techniques
  • Medical Devices

Background:

  • Cataract surgery requires intact zonular support for proper intraocular lens (IOL) placement.
  • Preoperative zonular deficiency and intraoperative zonular dialysis pose significant challenges during cataract surgery.
  • Existing techniques for managing zonular instability may have limitations.

Purpose of the Study:

  • To describe a novel surgical technique using a three-flanged Prolene suture for managing zonular dialysis.
  • To evaluate the efficacy and safety of this technique in a patient with preoperative zonular deficiency and brown cataract.
  • To demonstrate stable IOL positioning and good visual outcomes.

Main Methods:

  • A three-flanged Prolene suture was fashioned in an iris hook-like configuration.
  • The suture was passed through the zonular defect using a 26-gauge needle.
  • A capsular tension ring (CTR) was placed, and the suture engaged the dialysis site for stabilization.
  • The suture was secured, and an IOL was implanted in the capsular bag.

Main Results:

  • The three-flanged Prolene suture technique successfully managed zonular dialysis without intraoperative complications.
  • Postoperative visual acuity was 6/9 with normal intraocular pressure.
  • The IOL remained stable, indicating effective capsule stabilization and positioning.

Conclusions:

  • The three-flanged Prolene suture technique is a safe and effective method for managing zonular instability during cataract surgery.
  • This technique, combined with a CTR, ensures capsule stabilization and optimal IOL positioning.
  • It offers reliable outcomes for complex cases, including subluxated cataracts and intraoperative zonular dehiscence.