MORCHER

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MORCHER Capsular Tension Rings to stabilize the
capsule in cataract surgery
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(No Transcript)
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• APPROVED BY FDA

CTR enhances stability, centration of
capsular bag
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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
• Marfans and Weill Marchesani syndrome

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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

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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.
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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.

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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

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The MORCHER Capsular Tension Ring expands and
stabilizes the capsular bag facilitating
phacoemulsification, cortical aspiration, IOL
implementation and centration.
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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 14For Normal Eyes
Type 14AFor Highly Myopic Eyes
Type 14CFor Normal or Myopic Eyes
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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.

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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 1112.5mm
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Morcher Cionni Capsular Tension RingsFDA
Approved 10/14/2005
Morchers 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.
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Morcher Cionni Capsular Tension RingsFDA
Approved 10/14/2005
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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

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Insertion of the Capsular Tension Ring

• For IOL insertion, the order of placement
  doesnt 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

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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

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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.

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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.

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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.

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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.

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Also available at FCIMackool 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.

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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.

• 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).

Type 5S Pupil size 5.0 6.0mm
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CataractMorcher 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.
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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
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FCI Contact Information
Exclusive U.S. Distributor FCI OPHTHALMICS P.O.
Box 465 Marshfield Hills, MA 02051 Tel
800-932-4202 Fax [phone] Email
info_at_fci-ophthalmics.com Web www.fci-ophthalmics
.com