Flexible Nylon Retractors: From Pupil Expansion to Capsule Support, an Analysis and Description of the Required Modifications to the Surgical Technique.

In this report, we describe the technical modifications required for the safe and effective use of flexible nylon retractors for capsular support during phacoemulsification cataract surgery in cases of zonular weakness. This study presents an analysis of surgical adaptations that allow conventional flexible nylon "iris" retractors to be repurposed for capsular stabilization. The key modifications include altering the geometry of the retractor tip from a 180° hook to an open 120° angle, optimizing incision placement and architecture, and standardizing retractor tensioning to minimize capsular stress. Practical steps are outlined for rhexis engagement, incision positioning, and tension control to maintain capsular bag centration and reduce intraoperative complications. The modified technique was applied in a consecutive series of 28 eyes with varying degrees of zonular instability. No intraoperative anterior capsule tears or retractor slippages occurred following the introduction of the modified hook geometry, contrasting with previous experience using unmodified hooks. The modified approach provided stable capsular support throughout phacoemulsification, enabling controlled nucleus disassembly and intraocular lens implantation. Postoperative refractive outcomes were favorable, with 61% of eyes achieving a final refraction within 1.0 diopters of the target. We believe that flexible nylon retractors, when appropriately modified, represent a safe, practical, and cost-effective option for temporary capsular support in the presence of zonular weakness. The described modifications, particularly the reshaping of the distal hook and strategic incision placement, distribute forces more evenly along the capsulorhexis edge, reducing the risk of slippage or capsule tearing. These refinements enhance intraoperative stability and offer an effective alternative in settings where specialized capsule support devices are unavailable. Further comparative studies are warranted to validate these findings and quantify long-term outcomes.