Treatment of traumatic subluxation of the crystalline lens with custom-made capsular hook.

Objective: Traumatic rupture of the lens zonules, leading to lens dislocation, is common in clinical practice and often requires surgical treatment. We aim to study capsular hooks, formed from 5-0 or 6-0 polypropylene sutures by heat shaping, to fix the capsular bag and reshape the lens zonular.

Methods: A retrospective analysis was conducted on 16 patients (16 eyes) with traumatic subluxation of the crystalline lens who visited our department. Capsular hooks were fabricated using 5-0 or 6-0 polypropylene sutures, shape by heat, to fix the anterior capsular opening. The sutures passed out of the eye, punctured the sclera and traversed it parallel to the limbus for 2-3 mm, exiting through the conjunctiva to form a suture tunnel parallel to the limbus, securing the suture and preventing loosening. Changes in best-corrected visual acuity (BCVA) after surgery, intraocular lens centration, and surgical complications were assessed.

Results: Post-operative follow-up was 6-30 months, with an average of 10 ± 5.9 months. The BCVA improved from a pre-operative median of 2.15 (1.67) logMAR to a postoperative median of 0.25 (0.38) logMAR (paired sample Wilcoxon signed-rank test, Z = 3.516, p < 0.001). Postoperatively, the intraocular lenses were well-centered, the capsular bags were securely fixed, and no capsular hooks dislodgement occurred. One patient experienced combined vitreous hemorrhage during surgery. Another patient (case 2) developed rhegmatogenous retinal detachment 2 years post-surgery. After pars plana vitrectomy, the retina was reattached, and the final visual acuity remained stable.

Conclusion: Long-term follow-up data suggest that using custom-made capsular hooks offers a reliable solution for maintaining long-term stability of the capsular bag in patients with traumatic crystalline lens subluxation. This technique maintains the centering of the IOL postoperatively, showing effectiveness and safety, and it holds potential for broader clinical application.