This patient has a lens coloboma with about three clock hours of missing zonular support. This can make the surgery more challenging, starting with the beginning of the case. If too much trypan blue dye is used, it can go through this area of zonular loss and end up in the vitreous cavity thereby limiting the red reflex after the nucleus has been removed. You can also get vitreous prolapse through this gap, particularly if the anterior hyaloid face is disrupted. The surgeon in this video does something unusual: the capsular tension ring is placed prior to nucleus removal. To facilitate this, a simcoe device is used to flush out most of the cortex which is somewhat liquefied already. This approach works well and the case proceeds normally. Finally, the incision is widened since this patient receives a non-foldable PMMA IOL.
click to learn about white cataract surgery in the presence of a lens coloboma:
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