Anterior Capsular Fixation with the AssiAnchor – A Strategy for Proactive Stabilization in Severe Zonular Insufficiency: A Case Series

Aim: To determine the surgical outcomes and stability of anterior capsular fixation using the AssiAnchor device for management of subluxated crystalline lenses. Settings and Design: A retrospective case series conducted at a tertiary care ophthalmology centre. Materials and Methods: Six eyes from five patients with ≥3 clock hours of zonular weakness underwent phacoemulsification with capsular stabilization using a single AssiAnchor. Etiologies were post-traumatic subluxation ( n = 3) and Marfan syndrome ( n = 3). Surgeons inserted the AssiAnchor through a 2.8-mm clear corneal incision and sutured it to secure the anterior capsule before lens removal. Primary endpoints were intraoperative lens stability, IOL centration and complication rates. Secondary outcomes included best-corrected visual acuity and intraocular pressure over 12 months. Results: All surgeries were completed without intraoperative complications. Mean BCVA improved from 0.82 ± 0.16 log MAR preoperatively to 0.12 ± 0.06 log MAR at 12 months ( P < 0.001). No eye developed capsular phimosis, cystoid macular oedema, retinal detachment, or secondary glaucoma. Mean IOP remained stable (15.3 ± 2.1 mmHg preoperatively vs 14.9 ± 2.3 mmHg at 12 months; P = 0.47). Suture complications, IOL decentration and device migration did not occur. Conclusion: Anterior capsule fixation with the AssiAnchor safely stabilizes severely subluxated lenses, ensuring intraoperative control and sustained IOL centration without major complications. It serves as a dependable alternative to capsular tension rings or scleral-fixated IOLs in advanced zonular loss. Larger multicentre studies with longer follow-up should confirm durability.