Transcript Morcher Capsular Tension Rings PowerPoint

MORCHER® Capsular Tension Rings
to stabilize the capsule in cataract surgery
APPROVED BY FDA
CTR
enhances stability,
centration of capsular bag
Indications
The CTR is helpful in any situation in
which the surgeon questions the integrity
of the zonular apparatus
 Zonular damage
 Intraoperative, traumatic, or congenital zonular dialysis
 Zonular weakness due to:
 trauma
 Pseudoexfoliation
 Marfan’s and Weill Marchesani syndrome
Indications
 IOL Subluxation resulting from:
 Ocular trauma
 Postoperative capsular bag shrinkage leading to IOL
decentration
 tilting or closure of the capsular opening
 High Myopia:
 May lead to capsular shrinkage and/or fibrosis
 Soft IOL:
 Silicone IOLs and soft IOLs with disc designs tend to dislocate
High Risk to Routine
“The wonderful thing about this
technology is that it converts eyes at high
risk for problems from compromized
zonular integrity into routine cases.”
I. Howard Fine, M.D.
Overall Population
Affected
 Estimated target population: 2% to 5% of U.S.
cataract patients will need Capsular Tension Ring
support.
 Surgeons familiar with the Capsular Tension Ring say
it should be available for use in all cataract cases, as
it is often impossible to anticipate its need.
Advantages
 When placed in the capsular bag, the MORCHER® CTR:
 Keeps the bag stretched throughout the procedure allowing
greater safety during all intraocular manipulation
 Prevents concentration of forces on individual zonular fibers
by distributing all forces to the entire zonular apparatus
 The continuous pressure of the ring against the capsular
fornices bolsters the zonular traction on the capsule and
counters the force of constriction after metaplasia and
fibrosis of the capsulorhexis
The MORCHER® Capsular Tension Ring expands
and stabilizes the capsular bag facilitating
phacoemulsification, cortical aspiration, IOL
implementation and centration.
Product Description

MORCHER® Capsular Tension Rings are made of an open,
flexible, horseshoe-shaped filament of PMMA

They have eyelets at both ends to facilitate insertion, and
when expanded, the rings are larger than the capsule

They are available in 3 types: 14, 14A and 14C
Type 14
For Normal Eyes
Type 14A
For Highly Myopic Eyes
Type 14C
For Normal or Myopic Eyes
Sizing the Ring
Bulbus length
Type
Expanded
Compressible
Bulbus (axial)
length
14
12.3mm
To 10.0mm
 24mm
14A
14.5mm
To 12.0mm
 28mm
14C
13.0mm
To 11.0mm
24 – 28mm
The three rings are available in different diameters to accommodate
the variations in the eye size and also in the degree of zonular
damage:
 for eyes with fairly intact zonules but with a concern of late
zonulysis or capsular phymosis, you can use a smaller ring.
 for eyes with a large section of weakened zonules,
necessitating greater stability, a larger size may be the best
choice, even in a smaller eye.
Sizing the Ring
Corneal White to White
Type
Expanded
Compressed
White to White
14
12.3mm
To 10.0mm
 11mm
14A
14.5mm
To 12.0mm
 12.5mm
14C
13.0mm
To 11.0mm
11–12.5mm
Morcher® Cionni Capsular Tension Rings
FDA Approved 10/14/2005
Morcher’s Cionni CTRs are designed to stabilize the capsular bag in cases of
damaged or missing zonules. These rings are specially designed for scleral fixation
with suture.
Morcher® Cionni Capsular Tension Rings
FDA Approved 10/14/2005
Insertion of the
Capsular Tension Ring
 According to the level of zonular weakness, the ring
is inserted before or after phacoemulsification.

If zonules are strong enough, insertion is done after
nucleus and cortex removal

In cases of very weak zonules:
 Insertion is done before phacoemulsification
 Drawbacks: it complicates nucleofractis techniques
and cortex removal
Insertion of the
Capsular Tension Ring
 “For IOL insertion, the order of placement doesn’t
seem to matter.”
Howard V Gimbel, MD
 “On balance, I feel the benefit of having the ring in
place during surgery outweighs the inconvenience of
greater time spent removing cortex. It is still better to
leave a little cortex than take a little vitreous.”
Mark Packer, MD
Insertion of the
Capsular Tension Ring
Inserting the MORCHER Capsular tension ring
can be performed:
 Manually by using forceps to feed the device
into the eye and a Sinskey Hook inserted into
one of the eyelets to help maneuver the ring
into place.
 Using the Geuder ® Injector
Using the Injector
 Procedure:
 The hook of the injector is extended out
of the lumen by compressing the
plunger. The hook is then placed within
the left eyelet of the Capsular Tension
Ring, and the plunger is retracted to
draw the capsular ring into the injector.
Using the Injector
It is important to load the ring
properly onto the injector!
 You must follow the curvature of the
injector with the curvature of the ring
 Always load by hooking the LEFT eyelet.
Manufacturer
 Morcher® GmbH, Stuttgart, Germany, a
manufacturer of Intraocular Implants since
1951, received FDA approval in October, 2003
for marketing in the USA
 The Morcher® Capsular Tension Ring has been
used successfully in Europe since 1991 and is
known as a safe and effective device for
implantation.
Reimbursement for the CTR
 There is no specific code yet.
 The ambulatory surgery center or hospital outpatient
department may use a miscellaneous HCPCS code: L8699
prosthetic implant, not otherwise specified. Supporting
documentation concerning the ring will be required.
> For ambulatory surgery center, the Capsular Tension Ring
is reimbursed separately
> For hospital outpatient department, there's no separate
payment for the Capsular Tension ring: it is included in the
facility fee.
 The surgeon should file a claim for the surgical procedure alone
using CPT code 66982, complex cataract surgery.
 In the future: FCI Ophthalmics has applied for a new HCPCS
code for the Morcher® Capsular Tension Ring.
Also available at FCI
Mackool Capsular Support System
 Sometimes referred to as capsule
retention hooks, the Mackool CSS,
helps to hold the capsular bag in
place during cases with zonular
weakness.
 The CSS hooks may be used together
with capsular tension rings (CTR) by
helping to stabilize the bag for
surgery and delaying CTR insertion
until after the cortex has been
removed. The hooks are fitted with a
retainer tab to secure them in place
during surgery.
the Morcher® Pupil Dilator
 Advantages:
 The pupil dilator type 5S can be used with any
type of incision including corneal and scleral
tunnel approaches.
 No additional incisions are needed. It's
insertion and removal can be performed with
ordinary surgical instruments. It provides
physiological stretching of the pupil.
Type 5S
Pupil size: 5.0 – 6.0mm
 Contraindications:
 The pupil dilator 5S should be used only with
phacoemulsification.
 Do not use this temporary implant for delivery
of the nucleus in extracapsular surgery.
 Our Recommendation:
 For implatations of the pupil dilator using an
injector, we recommend the Geuder model
(type G-32970).
Cataract
Morcher® Pupil Dilator
The pupil dilator type 5S is a semicircular elastic PMMA ring for the expansion
of the pupil during phacoemulsification. It is supplied in sterile packing for single
use.
the Morcher® Pupil Dilator
for FLOMAX® patients
Intraoperative Floppy Iris Syndrome (IFIS) is a common side effect of
the medication Flomax®. David F. Chang, MD and John R. Campbell,
MD, recommend helpful strategies to dilate and control the iris using
a pupil dilator or iris retractors. (See April, 2005 Cataract & Refractive
Surgery Today for complete article.)
If you have a Flomax® patient, consider our:
Morcher®
Pupil Dilator
Iris Retractors
FCI Contact Information
Exclusive U.S. Distributor
FCI OPHTHALMICS
P.O. Box 465
Marshfield Hills, MA 02051
Tel: 800-932-4202
Fax: 781-826-9062
Email: [email protected]
Web: www.fci-ophthalmics.com