The child, a female born in 1990, complained of a gradual decrease in visual acuity and poor correction in recent years. Three years ago, the parents found that the child had poor visual acuity, and the child was diagnosed with “bilateral refractive error” at the local hospital and corrected by optometry. Two years ago, myopia worsened, astigmatism increased, and corrected visual acuity decreased. A year ago, the local hospital examined him again and found that the lens was subluxed in both eyes, and he was diagnosed with “bilateral congenital lens subluxation and bilateral refractive error”. Six months ago, he came to our hospital with visual acuity of 0.1 on the right and 0.3 on the left, and it was obvious that the optometry: right: -28.00DS+4.00DCA×110, corrected visual acuity of 0.3, left: -24.50DS+4.50DCA×75, corrected visual acuity of 0.3. Examination: both eyes had clear corneas and clear lenses, both lenses were shifted to the supra-nasal side with a spherical lens, and after dilated pupil, he could see The temporal suspensory ligament was relaxed and partially ruptured. X-rays and echocardiography were normal, and routine blood and urine tests were normal. Diagnosis: “Double congenital lens subluxation, double refractive error, double amblyopia”, surgical treatment was recommended. Treatment: Under general anesthesia, “bilateral lens removal + intracapsular tension ring (CTR) + artificial lens (IOL) implantation” was performed in our hospital. Two months later, “double capsular bag tension ring ciliary suture fixation” was performed. Visual acuity at 2 months postoperatively: 0.6 in the right and 0.6 in the left. apparent optometry: right: -2.00DS+1.25DCA×100, corrected visual acuity 0.8, left: -2.00DS+1.25DCA×55, corrected visual acuity 0.8. II. Clinical discussion Physician A: The child was diagnosed with congenital lens subluxation in both eyes, and treatment of such patients is more difficult. Usually, less severe lens dislocation is treated by lens prescription. If the dislocation is severe, surgery can be performed. In the past, lens removal + IOL ciliary suture fixation was mostly used, but with the improvement of surgical techniques, intracapsular band tension ring + IOL has been used in recent years, which has improved the treatment effect. This child has a gradual decrease in visual acuity with more increase in myopia and astigmatism, which is not suitable for lens treatment, and surgical treatment is more effective. Physician B: Intracapsular band tension ring + IOL surgery for congenital lens subluxation is a method adopted in recent years, the surgical technique is difficult and several key steps in the surgery right need attention. First, tearing of the capsule, complete with an anterior capsular ring is the key to successful surgery. Due to the laxity of the suspensory ligament, a small hole needs to be punctured in the anterior capsule first, and then the capsule is slowly torn with the capsule tearing forceps. Next, the lens cortex needs to be cleanly and thoroughly aspirated to minimize cortical residue and reduce the occurrence of posterior cataracts. Again, it is best to implant a folding IOL, as the capsule band and the tearing capsule opening are small and the folding lens is easy to implant. Physician C: Congenital lens subluxation mostly occurs in children, so the incidence of post-operative cataracts is relatively high. YAG laser treatment of post-operative cataracts is also available for these patients, but the treatment should not be done too early, usually after one month of suturing the tension ring. Children are less cooperative, and the laser should not bruise the IOL. Physician D: Currently there are still two options to choose from for the treatment of congenital lens subluxation, one is to use a tension ring, and the other is to fix the artificial lens with a suture in the ciliary sulcus. So how do you choose the patient? I believe that mild and moderate dislocations are treated with tension rings and severe ones are fixed with artificial lens ciliary sutures. For those with larger dislocations where the lens edge exceeds the midpoint of the pupil, there are often more suspension ligament ruptures. In these patients, it is very difficult to tear the anterior capsular ring and the surgery is extremely difficult, so it is recommended that direct suturing of the artificial lens is safer. The congenital lens subluxation is one of the rare lens diseases, and the patients are mainly children, so the treatment effect directly affects their future. The main manifestation of the patient is low vision, which is due to high myopia and astigmatism caused by the lens subluxation. Surgery should be considered early in patients with unsatisfactory corrected visual acuity, a trend toward decreased corrected visual acuity, or progressive increase in refractive error, as well as serious complications such as secondary glaucoma. Compared to traumatic lens subluxation, congenital lens subluxation is more difficult to operate, and there is a tendency for congenital lens subluxation with systemic abnormalities such as Marfan syndrome to progress, making congenital lens subluxation a more difficult lens disease to treat. There are several surgical options for treating congenital lens subluxation, and the entire procedure consists of two main parts: lens removal and IOL fixation. For lens removal, intracapsular or extracapsular removal of the lens can be performed, and in severe cases, transciliary flattening of the lens is an option, which also allows for a simultaneous vitrectomy. The IOL can be fixed with an anterior chamber IOL, an iris-fixed IOL, an IOL fixed with sutures in the ciliary sulcus, or an IOL and CTR implanted in the capsular bag. Traditional surgical treatment methods mostly involve lens removal, anterior vitrectomy and IOL fixed with sutures in the sclera, or anterior chamber IOL implantation, with many intraoperative and postoperative complications and poor long-term results. The main problems are: (1), the IOL is fixed only through two points, which is prone to tilt, and the optical part of the IOL is prone to pupillary entrapment; (2), the lens barrier is destroyed and prone to retinal detachment due to vitreous traction during surgery; (3), the surgical operation is large and long, and the postoperative inflammatory reaction is heavy; (4), if anterior chamber type IOL is used, it may cause secondary glaucoma, corneal endothelial cell number gradually decreases and other complications. Compared with traditional surgical methods, lens ultrasound aspiration combined with CTR and IOL implantation has the following advantages: (1) the IOL is located in a physiological position; (2) the lens barrier is preserved, effectively reducing the chance of retinal detachment due to postoperative vitreous traction; (3) the patient does not need to undergo vitrectomy, minimizing the disturbance to the vitreous tissue; CTR is performed mainly by expanding the equatorial part of the capsular bag to support the weak part of the suspensory ligament, thus redistributing the tension of the residual suspensory ligament and maintaining the stability of the bag. It can be used both as an intraoperative support aid and as an implant to maintain IOL stability over time. CTR is currently used more often for traumatic lens subluxation, and is less frequently reported for patients with congenital lens subluxation due to the complexity and difficulty of the surgical operation. It is worth noting that implantation of standard CTR alone does not result in ideal lens repositioning in severe subluxation, nor does it prevent progressive suspensory ligament rupture. Foreign scholars have designed new devices such as Modified Capsular Tension Ring (M-CTR) and Capsular Tension Segment (CTS) for these cases, and have achieved good results in clinical applications. However, these devices are not perfect, and various problems can still occur in practice.