Management of profound zonular dialysis or weakness with a new endocapsular ring designed for scleral fixation

The endocapsular tension ring has helped in the management of patients with moderate loss of zonular support. However, the eye with profound zonular dialysis or weakness may require scleral fixation of the ring for centration and long-term stabilization. We used a new, modified endocapsular tension ring designed to provide scleral support without violating the integrity of the capsular bag in 4 patients. All patients had extreme loss of zonular support preoperatively or a significant risk of progressive zonular weakness. In each case, the new ring provided excellent support and centration of the capsular bag and intraocular lens intraoperatively and postoperatively.