CTR Master Class Course

ASCRS 2010, Boston. CTR Master Class Course 11-307. Course Handout Instructor: Brian Little Faculty: Som Prasad 1 | Brian Little [email protected] ; Som Prasad [email protected]; United Kingdom Introduction Capsular Tension Rings (CTRs) have been available since 1993 in Europe but have only recently gained FDA approval for use in the United States. They have contributed significantly to improved safety and better outcomes in eyes with compromised zonules and consequently are now in more widespread use. They are easy to understand in principle but in practice there are many pitfalls and some unique complications that are associated with their use. This is especially true for the inexperienced surgeon and occasional user. This course c overs the different types of CTR's (plain, sutured, segments) and their pre-planned ("cold") and unplanned ("hot") use. It offers some very practical tips and tricks for their reliable and safe insertion and also demonstrates how things can go wrong, how to avoid these problems and what to do when they happen. It is supported by extensive examples and illustrated with high quality video. The experience of the faculty with the use of CTRs is over 20 man-years. Background The first CTR was designed by Drs. Witschel and Legler and presented at the Cataract, I OL, and Refractive Surgery symposium in May 1993. It was an open C -loop design intended to buttress either missing or weakened zonules by implantation within the capsular bag. Its presence acts to circularize the capsular bag by outward expansion into the capsular fornix under its own elastic recoil. By doing so it diffusely supports the zonules and thereby minimizes capsular phimosis and shrinkage, w hich is the cause of post-operative decentration and sometimes dislocation of the bag/I OL complex. We need to be mindful that CTRs are only one component of a “system”, if you like, of zonular support that includes both zonular-friendly surgical techniques and the use of capsular anchors (iris hooks over the rhexis) to reduce further stress on already compromised zonules. Broadly these are the two situations that call for the use of a CTR. The fir rst is the “cold” or

CTR Master Class Course

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