Three-flanged capsular hook for zonular dialysis repair

To describe a surgical technique using a three-flanged Prolene suture for managing zonular dialysis during cataract surgery in a patient with preoperative zonular deficiency in brown cataract. A patient with zonular deficiency and brown cataract underwent cataract surgery complicated by zonular dialysis between the 4 o'clock and 8 o'clock positions. A three-flanged Prolene suture, fashioned in an iris hook-like configuration, was used. A 26-gauge needle was introduced at the 6 o'clock position to pass a 7-0 Prolene suture through the zonular defect. A capsular tension ring (CTR) was placed to stabilize the anterior capsule, and the Prolene suture was engaged at the dialysis site. The suture was cut, cauterized, and buried under the conjunctiva. An intraocular lens was implanted in the capsular bag. Postoperative visual acuity was 6/9, and intraocular pressure was normal. There were no intraoperative complications. The zonular dialysis was effectively managed, and the Intraocular lens (IOL) remained stable. The three-flanged Prolene suture technique is an effective method for managing zonular instability during cataract surgery. Combined with a CTR, it ensures capsule stabilization and IOL positioning, providing reliable outcomes in cases of zonular deficiency, including subluxated cataracts and intraoperative zonular dehiscence.