This patient has a dense cataract and a surprise waiting for the surgeon: as the nucleus is being cracked, we notice a dark shadow seen under the iris at the pupil margin. This is because the nucleus is being pushed posteriorly due to lack of good zonular support. How should you proceed with phaco? Should you implant a capsular tension ring (CTR)? What about IOL choice and positioning? While the posterior capsule remains intact for this case, the challenges are many!
click below to see how to successfully complete this tough cataract surgery: