Early lens centralization with a novel capsular tension segment in severe zonular weakness

Capsular tension rings (CTRs) and its modifications have been used for more than 2 decades to support zonular weakness in ectopia lentis. We describe a novel capsular tension segment (CTS) that is implanted with a standard CTR and inserted through a 1.0 mm peripheral minirhexis. The CTS features a central fixation eyelet that allows scleral fixation with a 6-0 polypropylene suture secured by flanges. Early placement of the CTR–CTS complex re-establishes circumferential zonular tension before capsulorhexis and lens aspiration, thereby maintaining the integrity of the vitreous compartment. In a 16-year-old patient with Marfan syndrome and crystalline lens subluxation, the technique enabled a swift and controlled capsulorhexis, uneventful bimanual aspiration, and a successful implantation of a foldable intraocular lens within the capsular bag. The approach provides predictable centering of the lens–capsule complex and reduces the risk of vitreous prolapse, posterior capsular rupture, and dropped nucleus in eyes with weak zonular fibers.