This is a case where we knew ahead of time there would be issues. The patient is mid 50s in age and he had a pars plana vitrectomy, membrane peeling, and pan retinal photocoagulation laser done just three weeks ago for proliferative diabetic retinopathy. The lens went from relatively clear to a white cataract in the few weeks after the pars plana vitrectomy. That surely means that there is a violation of the lens capsule and that this cataract surgery will be quite the challenge!
At the start of the case, we can see that the anterior lens capsule is sunken in and concave even though we expect it to be the opposite. We realize immediately that the prior vitrectomy resulted in the violation of the lens capsule and that is why we now have a white cataract. This case involves both an anterior segment surgeon and posterior segment surgeon together to complete the case successfully.
Click to watch this video with four hands, two surgeons, and two machines: