ARTICLE

Subluxated cataract lens surgery using

sutured segments or rings and
implantation of toric intraocular lenses
Anna T. Do, MD, Huck A. Holz, MD, Robert J. Cionni, MD

PURPOSE: To evaluate the intraoperative performance and postoperative outcomes of toric

intraocular lens (IOL) with suture ring implantation in adult patients with subluxated lenses.
SETTING: Department of Ophthalmology, Kaiser Permanente, Santa Clara, California, and the Eye
Institute of Utah, Salt Lake City, Utah, USA.
DESIGN: Retrospective case review.
METHODS: Eyes with subluxated cataractous lenses and preoperative corneal astigmatism having
toric IOL implantation with a sutured ring or segment were studied. Preoperative and postoperative
analyses included uncorrected distance visual acuity (UDVA), corrected distance visual acuity
(CDVA), and cylindrical power postoperatively and 3, 6, and 12 months postoperatively.
RESULTS: Twenty-one eyes of 15 patients were studied. The median follow-up was 14.6 months.
The mean CDVA at the final follow-up (0.10 logMAR G 0.15 [SD]) was significantly improved from
the mean preoperative CDVA (0.73 G 0.40 logMAR). Postoperative cylindrical power was
significantly improved in all patients (mean reduction in astigmatism 2.37 G 1.46 diopters).
Patients who required postoperative enhancement had anterior laser capsulotomy for bilateral
capsule phimosis (2 eyes), photorefractive keratectomy (1 eye), pupilloplasty (1 eye), and
posterior laser capsulotomy (2 eyes).
CONCLUSION: Cataract removal and implantation of a toric IOL combined with a sutured ring or
segment capsule stabilizing device was a safe and efficacious long-term solution for patients
with subluxated cataract lenses and corneal astigmatism.
Financial Disclosure: Dr. Cionni has a financial interest in the modified capsular tension ring.
Neither of the other authors has a financial or proprietary interest in any material or method
mentioned.
J Cataract Refract Surg 2016; 42:392398 Q 2016 ASCRS and ESCRS
Online Video

Cataract can present with diffusely compromised zon-
ular fibers, as is commonly found in Weill-Marchesani
syndrome, pseudoexfoliation syndrome, and homo-
cystinuria. Focal zonular loss commonly occurs as a
result of ectopia lentis, Marfan syndrome, sulfate
oxidase deficiency, and trauma. Cataract surgery
with intraocular lens (IOL) implantation in eyes with
diffuse zonular loss presents a greater surgical chal-
lenge than in eyes with focal zonular loss; however,
in both instances, patients should be made aware of
the higher associated rates of complications.1 Surgery
is most often offered when the corrected distance
visual acuity (CDVA) is limited or threatened by irreg-
ular lenticular astigmatism, cataract change, or angle-
closure glaucoma.
In patients with extensive zonular weakness, endo-
capsular support devices such as sutured modified
capsular tension rings (CTRs) or the Ahmed capsular
tension segment (CTS) are helpful in promoting long-
term stability of the IOLcapsule system.2,3 Capsular
tension rings are widely used to compensate for
limited zonular defects during cataract extraction
and can help prevent eccentric capsule contraction
with subsequent IOL decentration.4 For zonular loss

392 Q 2016 ASCRS and ESCRS http://dx.doi.org/10.1016/j.jcrs.2015.10.070

Published by Elsevier Inc. 0886-3350
 TORIC IOL IMPLANTATION FOR LENS SUBLUXATION
Figure 1. Preoperative view of subluxated cataractous lens due to
zonular compromise.
greater than 4 clock hours, scleral suture fixation of a
CTS or sutured CTR is often warranted to promote
capsule centration and stability. These scleral-sutured
elements might lead to potential complications,
including erosions over the sutures, induced astigma-
tism, and delayed IOL subluxation from broken
sutures.5
Toric IOLs have been shown to safely and effectively
reduce or neutralize corneal astigmatism in appropri-
ately selected patients having cataract extraction.6
These IOLs might be considered an option for patients
with evidence of zonular compromise. Here we report
our experience with combined placement of toric IOLs
with a modified CTR and/or CTS scleral fixation
device in eyes with diffuse or focal zonular compro-
mise requiring cataract surgery.
PATIENTS AND METHODS
This retrospective observational study was performed in
accordance with the Declaration of Helsinki, and the study
protocol was approved by the Institutional Review Board,
Kaiser, Santa Clara Hospital, Santa Clara, California. All
patients of any age with lens subluxation or phacodonesis
from any etiology who had cataract extraction requiring
Submitted: August 13, 2015.
Final revision submitted: September 30, 2015.
Accepted: October 4, 2015.
From the School of Medicine (Do), Stanford University, Palo Alto,
and Kaiser Permanente (Holz), Santa Clara, California; the Eye
Institute of Utah (Cionni), Salt Lake City, Utah, USA.
Corresponding author: Huck A. Holz, MD, Kaiser Permanente
Santa Clara, Ophthalmology Department, Suite 490, 710 Lawrence
Expressway, Santa Clara, California 95051, USA. E-mail: huck.
holz@kp.org.
J CATARACT REFRACT SURG - VOL 42, MARCH 2016
393
Figure 2. Intraoperative view of sutured ring segment with aligned
toric IOL.
placement of a sutured ring or Ahmed segment in combina-
tion with a toric IOL (all IOLs, Alcon Laboratory, Inc.)
between 2010 and 2014 were included in the study.
Preoperative data collected included CDVA, manifest
refraction, cylindrical power, keratometry values, and
degree of zonular defect. Figure 1 shows a preoperative
view of a subluxated cataractous lens due to zonular
compromise. Automated and manual keratometry measure-
ments were taken, and biometry was performed to deter-
mine the appropriate IOL spherical power to achieve the
patient's selected refractive target. Cylindrical power and
axis placement were calculated using the Alcon toric intraoc-
ular lens calculator.A Postoperative data included CDVA at
each follow-up visit, postoperative enhancement proce-
dures, postoperative refraction, and outcomes. One of 2
surgeons (H.A.H., R.J.C.) performed all surgeries.
Because these cases tend to be challenging, the surgical
technique might have varied somewhat from patient to
patient and between the 2 surgeons. Video 1 (available at
http://jcrsjournal.org) exemplifies the typical case, which
consisted of a 2.4 mm clear corneal incision with 1 or
more paracenteses followed by creation of a continuous
curvilinear capsulorhexis whereupon hydrodissection and
viscodissection were used to free the nucleus. The cataract
nucleus was extracted using a quick-chop phacoemulsifica-
tion or a divide-and-conquer technique assisted by the use
of capsular support hooks as necessary. The cortical material
was then removed with a combination of an irrigation/
aspiration (I/A) handpiece and a bimanual I/A unit. An
appropriately sized CTR was then placed in the capsular
bag for circumferential zonular support followed by a CTS
that was placed in the area of greatest zonular weakness
and sutured to the sclera 2.0 mm posterior to the limbus
using a 9-0 polypropylene (Prolene) or a 8-0 polytetrafluoro-
ethylene (Gore-Tex) suture through a Hoffmann et al.
pocket.7 The toric IOL was implanted and aligned with the
intended axis to best achieve astigmatism neutralization.
The ophthalmic viscosurgical device (OVD) was then
removed with I/A, and the wounds were sealed with
stromal hydration and sutured when necessary.
The surgical technique for patients requiring a sutured
modified CTR consisted of a similar procedure except that
after the cortex was removed, a sutured Cionni ring was
fixated to the sclera with a 9-0 polypropylene or an 8-0
394 TORIC IOL IMPLANTATION FOR LENS SUBLUXATION

Table 1. Preoperative and postoperative clinical data for patients 1 through 6.

Parameter Patient 1 Patient 2 Patient 2

Surgeon H.A.H. H.A.H. H.A.H.

Sex F F F
Age (y) 40 47 47
Eye OS OS OD
Etiology of Subluxation Familial ectopia lentis Marfan syndrome; Marfan syndrome;
congenital ectopia lentis congenital ectopia lentis

Preoperative
CDVA 20/40
2 CF 30 20/200
LogMAR CDVA 0.301 1.301 1
Manifest refraction
5.75 C2.25  45
13.75 C4.75  70
3.00 C1.50  180
Astigmatism 2.25 4.75 1.50
Manual steep K (D@o) 42.20@77 43.23@11 42.01@61
Manual flat K (D@o) 40.22@16 40.86@21 40.78@15
Corneal astigmatism (D) 1.99 2.36 1.24
Comorbidities Diabetes without retinopathy Marfan syndrome Marfan syndrome

Degrees of zonular defect Superior subluxation nearly 180 180

to visual axis
Intraoperative
Vitrectomy performed Anterior, vitreous around No No
zonules
IOL model 18.0 D, SN6AT5 26.5 D, SN6AT3 26.5 D, SN6AT3
Suture model 9-0 polypropylene 9-0 polypropylene 9-0 polypropylene
Scleral fixation device Ahmed segment C Morcher Ahmed segment C Morcher Ahmed segment C Morcher
CTR 14 CTR 14 CTR 14
Complications None None None
Postoperative
Enhancement d Anterior capsular phimosis; Anterior capsular phimosis;
Nd:YAG laser Nd:YAG laser
1-mo UDVA 20/25 20/30C 20/25C
1-mo CDVA 20/20
2 20/25 20/25
3-mo UDVA 20/25 20/30C 20/25C2
3-mo CDVA 20/25 20/25
2 20/25
2
6-mo UDVA d 20/30
1 20/25C2
6-mo CDVA d 20/25
2 20/20
2
12-mo UDVA 20/25
2 d d
6-mo CDVA 20/25 d d
Final UDVA 20/25
2 20/30
1 20/25C2
Final logMAR UDVA 0.129 0.23 0.58
Final CDVA 20/20 20/25
2 20/20
2
Final logMAR CDVA 0 0.129 0.058
Final refraction
1.25 C0.75  140
0.05 C0.75  5
0.25 C0.25  160
Postop cylinder 0.75 0.75 0.25
Total FU (mo) 41 9 6
Late complications Mild PCO Anterior capsule phimosis Anterior capsule phimosis

AMD Z age-related macular degeneration; CDVA Z corrected distance visual acuity; CF Z counting fingers; CTR Z capsular tension ring; FU Z follow-up;
IOL Z intraocular lens; Nd:YAG Z neodymium:YAG laser capsulotomy; PCO Z posterior capsule opacification; PRK Z photorefractive keratectomy;
UDVA Z uncorrected distance visual acuity

polytetrafluoroethylene suture. The toric IOL was then calculator.A The OVD was then removed with I/A, and the
implanted and aligned with the steep axis of astigmatism wounds were sealed. Figure 2 shows an intraoperative
according to the calculations done by the Alcon toric IOL view of a sutured Ahmed CTS aligned with toric IOL.

J CATARACT REFRACT SURG - VOL 42, MARCH 2016

 TORIC IOL IMPLANTATION FOR LENS SUBLUXATION 395

Table 1. (Cont.)

Patient 3 Patient 4 Patient 5 Patient 6 Patient 6

H.A.H. H.A.H. H.A.H. R.J.C. R.J.C.

M M F M M
88 40 71 51 51
OD OS OD OS OD
Penetrating ocular injury Traumatic cataract with Familial ectopia lentis Weil-Marchesani Weill-Marchesani
with corneal laceration zonular dehiscence; Syndrome Syndrome
and zonular compromise sphincter tears

20/200 20/200 20/60 20/200 20/60

1 1 0.477 1 0.477

7.25 C5.00  85
9.75 C1.25  150
7.00 C2.00  70
6.25 C7.00  095
6.75 C5.50  94
5.00 1.25 2.00 7.00 5.50
44.6@89 43.78@99 46.38@95
40.70 42.53@9 40.63@8
3.90 1.25 6.75 5.75 5.57
Traumatic corneal Presbyopia, hyperlipidemia; Urticaria, osteoporosis, ocular Weill-Marchesani Weill-Marchesani
scar; dry AMD chronic low back pain myasthenia gravis; diabetes; syndrome syndrome
obstructive sleep apnea
180 180 180 d d

No No No No No

18.0 D, SN6AT5 9 D, SN6AT3 18.0 D, SN6AT7 SN6AT5 SN6AT5

9-0 polypropylene 9-0 polypropylene 9-0 polypropylene 9-0 polypropylene 9-0 polypropylene
Cionni 1L CTR Ahmed segment C Morcher Ahmed segment C Morcher Modified CTR Modified CTR
CTR 14 CTR 14
None None None None None

PRK d d d d

20/40
1 d 20/20
2 d d
20/30 20/30 20/20 20/50 20/40
20/80 20/60C2 20/15
20/30
1 20/20
1 20/30 20/40
20/40 d 20/15
d d d 20/40C2 20/50C2
d d d d d
d d d 20/25C1 20/60C2
20/40 20/60C2 20/15 d
0.301 0.462
0.125
20/30 20/20
1 20/15 20/25C1 20/60C2
0.176 0.019
0.125 0.116 0.42
Plano C0.75  135
1.50 C0.50  120 Plano
0.50 C2.75  83
1.25 C4.25  96
0.75 0.51 0.00 2.75 4.25
26 3 6 50 50
None None None None None

The CDVA was measured on the Snellen chart and preoperatively was analyzed using the 2-tailed Student
converted to logMAR values for statistical analysis. The t test. A P value less than 0.05 was considered statistically
change in mean the CDVA postoperatively compared with significant.

J CATARACT REFRACT SURG - VOL 42, MARCH 2016

396 TORIC IOL IMPLANTATION FOR LENS SUBLUXATION
RESULTS
Overall, 21 eyes of 15 patients aged 21 to 88 years old
met the inclusion criteria. Etiologies of lens subluxa-
tion included Marfan syndrome (5 eyes), familial ecto-
pia lentis (4 eyes), trauma (3 eyes), Weill-Marchesani
syndrome (2 eyes), and congenital subluxated crys-
talline lens (1 eye). The mean age at surgery was
53.5 years G 17.9 (SD). Patients were followed for a
mean of 14.6 G 16.3 months (range 1 to 41 months;
median 12 months). The Table 1 shows preoperative
and postoperative clinical data for each patient.
Patient 1 developed mild posterior capsule opacifi-
cation (PCO), and patient 2 required a neodymium:
YAG capsulotomy for bilateral anterior capsule
phimosis. Patient 3 had photorefractive keratectomy
postoperatively to correct residual corneal astigma-
tism because toric IOLs were only U.S. Food and
Drug Administration (FDA)approved up to the
SN6AT5 models and this was inadequate to correct
the total amount of astigmatism. Patient 7 had pupillo-
plasty for mydriasis causing glare, and patient 9 had
laser capsulotomy for PCO. The most common post-
operative complication was PCO (3 eyes) (20.0%),
with 2 eyes (13.3%) requiring laser capsulotomy. There
were no cases of postoperative retinal detachment,
endophthalmitis, or glaucoma.
Table 2 shows the visual outcomes. The improve-
ment in the CDVA from preoperatively to postopera-
tively was statistically significant (P ! .001). Overall,
21 eyes (87.5%) achieved a UDVA of 20/40 or better
and 9 eyes (37.5%) a UDVA of 20/25 or better at the
final follow-up. The mean postoperative cylindrical
power was reduced by 2.37 D, a mean astigmatism
reduction of 74.7%.
DISCUSSION
The use of toric IOLs, particularly in patients with
Marfan syndrome and ectopia lentis who have known
collagen synthesis disorders, has the advantage of
improving uncorrected visual acuity while avoiding
the use of postoperative laser vision correction on cor-
neas that are more prone to ectasia.8 Only a handful of
case reports describe combined implantation of a toric
IOL with a CTR in adult patients. One study9 used a
CTR in the implantation of a toric IOL to correct astig-
matism after keratoplasty in a single patient with cata-
ract and noted the use of a CTR might improve long-
term stability. A separate report by Rekas et al.10
astigma-
described a case of megalocornea and corneal
tism with nuclear sclerotic cataract that was corrected
by implanting a toric IOL. The IOL was first stabilized
by suturing it to a CTR and then placing the IOLCTR
complex into the lens capsule and aligned with the
steep meridian of the corneal astigmatism. A third
J CATARACT REFRACT SURG - VOL 42, MARCH 2016
report by Kandar11 describes a case of an 18-year-old
man who had phacoemulsification and implantation
of a CTR and toric IOL to correct a subluxated trau-
matic cataract who had high corneal astigmatism after
deep anterior lamellar keratoplasty. Finally, Gimbel
et al.12 reported a good result of bilateral implantation
of modified CTR and toric IOLs in a 16-year-old girl
with bilateral ectopia lentis secondary to Marfan
syndrome. Other than these specific reports, there
are no previous reports of the use of the Ahmed CTS
or the modified CTR in toric IOL implantation for
lens subluxation.
This series shows that patients with astigmatism
and subluxated lenses resulting from zonular compro-
mise can be successfully managed by combined
implantation of a sutured capsule support device
with a toric IOL. Although this technique broadens
the scope of patients who might benefit from toric
IOL placement, standard criteria for the selection of
patients who are appropriate candidates for a toric
IOL should still be considered, namely that patients
with more regular corneal astigmatism will experience
a more predictable benefit from toric IOLs. Some
authors have commented that the forces created by
suturing a CTR to the sclera can cause irregular astig-
matism,13 which would be problematic for accurate
alignment of a toric IOL. In our experience, scleral
fixation of the IOLbag complex did not appear to
induce clinically significant astigmatic forces.
Three of the eyes in our study (patient 3, 1 eye;
patient 6, both eyes) were operated on before the
introduction of higher power astigmatism-reducing
toric IOLs in 2012. Toric IOLs were implanted in these
cases to allow for reduced astigmatism correction with
the use of spectacles, thereby allowing for thinner,
lighter glasses. In addition, patient 4 chose a myopic
target to compensate for his presbyopia. Thus, the in-
clusion of these 4 cases in part diminishes the mean
reduction in astigmatism and/or UDVA in the total
sample. Another factor to consider is that many of
these eyes have developed mild to moderate refractive
amblyopia or other limitations and comorbidities.
For example, patient 3 had age-related macular degen-
eration that limited his final CDVA. For these reasons,
the visual outcomes in this study should not be
compared directly with the FDA study of normal
healthy eyes. After excluding patients 3, 4, and 6,
who had surgery before the 2012 release of the higher
power IOLs or had an intentional target of myopia,
the calculated mean postoperative UDVA excluding
these 4 cases was 0.136 logMAR.
This report is limited by its small sample, in part
because patients with subluxated lenses and signifi-
cant corneal astigmatism represent a small subset of
the population. The length of follow-up for some
 TORIC IOL IMPLANTATION FOR LENS SUBLUXATION
Table 2. Visual outcomes.
Outcome
Mean preop CDVA (logMAR) G SD
Mean postop CDVA (logMAR) G SD
Mean postop UDVA (logMAR) G SD
% eyes achieving UDVA R20/40
% eyes achieving UDVA R20/25
Mean preop keratometric cylinder (D) G SD
Mean postop cylinder (D) G SD
Mean % astigmatism reduction
Mean reduction in astigmatism (D) G SD
% with residual refractive astigmatism of 0.75 D
CDVA Z corrected distance visual acuity; UDVA Z uncorrected distance visual acuity
*Excluding patients 7, 9, and 10
Excluding patients 3, 4, 6, 7, 9, and 10
patients in the study was also relatively short, and it
remains to be seen what the long-term stability of these
interventions will be; however, it is expected that
it will be similar to that in previously published re-
ports describing combined CTR placement with
monofocal IOLs in adult and pediatric patients with
subluxated lenses.2,14,15
In conclusion, cataract surgery with toric IOL
implantation combined with sutured capsule support
rings or segments in the setting of zonular compromise
offered safe, effective, and predictable improvement in
CDVA.
WHAT WAS KNOWN
 Endocapsular support devices such as modified CTRs and
CTSs have been widely used in cases of zonular compro-
mise to stabilize the IOLcapsule system during cataract
extraction.
 Toric IOLs have been used to safely and effectively correct
corneal astigmatism.
WHAT THIS PAPER ADDS
 Combined implantation of toric IOLs with endocapsular
support devices was performed in cases of subluxated
cataracts with zonular compromise with safe and predict-
able long-term improvements in visual acuity.
 The use of toric IOLs, in particular in patients with Marfan
syndrome and other known collagen synthesis disorders,
can improve the UDVA and help avoid the use of postop-
erative laser vision correction on corneas that are more
prone to ectasia.
J CATARACT REFRACT SURG - VOL 42, MARCH 2016
397
All Eyes Excluding Patients 3, 4, and 6
0.73 G 0.40 0.63 G 0.43
0.10 G 0.15 0.06 G 0.13
0.197* G 0.24 0.136 G 0.25
87.50 90.91
37.50 81.81
3.18 G 1.66 2.83 G 1.43
0.80 G 1.21 0.34 G 0.03
74.70 88.01
2.37 G 1.46 2.49 G 1.57
86.67 100
REFERENCES
1. Kazemi S, Wirostko WJ, Sinha S, Mieler WF, Koenig SB,
Sheth BP. Combined pars plana lensectomy-vitrectomy with
open-loop flexible anterior chamber intraocular lens (AC IOL)
implantation for subluxated lenses. Trans Am Ophthalmol Soc
2000; 98:247251. discussion, 251253. Available at: http://
www.ncbi.nlm.nih.gov/pmc/articles/PMC1298230/pdf/taos00001-
0249.pdf. Accessed December 10, 2015
2. Cionni RJ, Osher RH, Marques DMV, Marques FF, Snyder ME,
Shapiro S. Modified capsular tension ring for patients with
congenital loss of zonular support. J Cataract Refract Surg
2003; 29:16681673
3. Hasanee K, Ahmed K II. Capsular tension rings: Update on
endocapsular support devices. Ophthalmol Clin North Am
2006; 19:507519
4. Menapace R, Findl O, Georgopoulos M, Rainer G, Vass C,
Schmetterer K. The capsular tension ring: designs, applications,
and techniques. J Cataract Refract Surg 2000; 26:898912
5. Jacob S, Agarwal A, Agarwal A, Sathish K, Prakash G,
Kumar DA. Glued endocapsular hemi-ring segment for fibrin
glueassisted sutureless transscleral fixation of the capsular
bag in subluxated cataracts and intraocular lenses. J Cataract
Refract Surg 2012; 38:193201
6. Holland E, Lane S, Horn JD, Ernest P, Arleo R, Miller KM. The
AcrySof toric intraocular lens in subjects with cataracts and
corneal astigmatism; a randomized, subject-masked, parallel-
group, 1-year study. Ophthalmology 2010; 117:21042111
7. Hoffman RS, Fine IH, Packer M. Scleral fixation without conjunc-
tival dissection. J Cataract Refract Surg 2006; 32:19071912.
Available at: http://www.finemd.com/reprints/Scleral%20Fixa
tion%20Without%20Conjunctival%20Dissection.pdf. Accessed
December 10, 2015
8. Maumenee IH. The cornea in connective tissue diseases.
Ophthalmology 1978; 85:10141017
9. Amm M, Halberstadt M. Implantation torischer Intraokularlinsen
zur Korrektur hoher postkeratoplastischer Astigmatismen [Im-
plantation of toric intraocular lenses for correction of high post-
keratoplasty astigmatism]. Ophthalmologe 2002; 99:464469
10. Rekas M, Pawlik R, Klu
s A, Ro
zycki
_ R, Szaflik JP, O1dak M.
Phacoemulsification with corneal astigmatism correction with
the use of a toric intraocular lens in a case of megalocornea.
J Cataract Refract Surg 2011; 37:15461550
398 TORIC IOL IMPLANTATION FOR LENS SUBLUXATION

11. Kandar AK. Combined special capsular tension ring and toric 15. Vasavada V, Vasavada VA, Hoffman RO, Spencer TS,
IOL implantation for management of post-DALK high regular Kumar RV, Crandall AS. Intraoperative performance and post-
astigmatism with subluxated traumatic cataract. Indian J operative outcomes of endocapsular ring implantation in pediat-
Ophthalmol 2014; 62:819822. Available at: http://www.ncbi. ric eyes. J Cataract Refract Surg 2008; 34:14991508
nlm.nih.gov/pmc/articles/PMC4152657/?reportZprintable. Ac-
cessed December 10, 2015 OTHER CITED MATERIAL
12. Gimbel HV, Camoriano GD, Aman-Ullah M. Bilateral implanta- A. Alcon Surgical, Inc. AcrySof Toric IOL Web Based Calculators.
tion of scleral-fixated Cionni endocapsular rings and toric intra- Available at: http://www.acrysoftoriccalculator.com. Accessed
ocular lenses in a pediatric patient with Marfans syndrome. December 12, 2015
Case Rep Ophthalmol 2012; 3:1623. Available at: http://www.
ncbi.nlm.nih.gov/pmc/articles/PMC3357140/pdf/cop-0003-0016.
pdf. Accessed December 10, 2015
First author:
13. Kim W-S. Transscleral intraocular lens fixation with preser-
Anna T. Do, MD
vation of the anterior vitreous face in patients with Marfan
syndrome and ectopia lentis. Cornea 2010; 29(suppl 1): From the School of Medicine,
S20S24 Stanford University, Palo Alto,
14. Konradsen T, Kugelberg M, Zetterstro m C. Visual outcomes and
California, USA
complications in surgery for ectopia lentis in children. J Cataract
Refract Surg 2007; 33:819824

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