The anterior lens capsule should be taut and securely held by the zonular structures so that it is like the head of a drum. When we poke into the anterior lens capsule with our forceps or a cystotome, it should puncture easily. But if we see radial wrinkles from our attempted puncture, this indicates zonular laxity and a loose anterior lens capsule. This is a danger sign.
In this case we have even more challenges: we are dealing with a dense cataract in a truly monocular patient and he is not fully cooperative. Due to his advanced age (95 years old) and his systemic medical issues, he is unable to have more intra-venous sedation. But we need to help this patient see, so we take the needed measures to complete his cataract surgery.
Click below to watch this challenging cataract surgery case: