Severe zonular deficiency remains one of the most challenging situations during cataract surgery, particularly when preservation of the capsular bag is desired. Modified capsular tension rings (mCTRs), including Cionni-type rings, provide adequate capsular support but often require technically demanding scleral suturing and knot burial. This article describes a simplified surgical technique for scleral fixation of an mCTR using a prethreaded needle–assisted approach combined with a flanged 6-0 polypropylene suture. The method allows controlled transscleral suture passage, precise centration of the capsular bag, and knotless scleral fixation with minimal intraocular manipulation. A representative clinical application is presented to demonstrate feasibility. This technique may be considered in selected cases of severe zonular weakness requiring reliable capsular stabilization during cataract surgery.
Iqbal et al. (Thu,) studied this question.