Fig. 81. In a case that preceded the availability of endocapsular rings, preoperative trauma created a 5 o'clock hour zonular dialysis in this eye. Despite this, phacoemulsification was accomplished and most of the cortex was removed. An IOL was placed within the ciliary sulcus using a double McCannel suture technique. The inferior suture can be seen at the inferior border of the slit-lamp beam. Because there is no zonular support, the unsupported capsule has contracted and is beginning to encroach on the visual axis. A capsular tension ring placed at the time of surgery would prevent the central encroachment of this contracture. (Courtesy of James A. Davison, MD, Wolfe Eye Clinic, Marshalltown, IA.)