This seemed like a typical white cataract during the pre-operative exam and when first placed under the surgical microscope on the day of surgery. However, after instilling trypan blue dye to stain the anterior lens capsule, we see that it is wrinkled and fibrotic. Performing a capsulorhexis will be challenging because these fibrotic bands will hinder accurate tearing of the anterior capsule. In addition, we need to watch out for zonular instability since that is often associated with a wrinkled anterior lens capsule. If you have access to a femtosecond laser (about $500,000 USD), then you could use it to perform the anterior lens capsulotomy, but even that may not guarantee the result. In this video, we show a technique that can be done with the instruments that you already have.
click below to learn how to deal with a fibrotic anterior lens capsule: