This is a very challenging surgery and most surgeons would rate it a 9 or 10 out of 10 in terms of difficulty. And let me tell you that this video is going to make other experts leave comments with alternatives that they would have pursued in the surgical judgment decision tree. In fact, I would choose a different method of IOL placement in this eye. And that is normal since we each have our own preferences and techniques, understanding that there is not just one way to approach any given case. Our guest surgeon, Guillermo Amescua MD from Bascom Palmer Eye Institute in Miami, is a true expert in difficult cataract cases and I have admired his work for many years. He does a fantastic job with this tough case… but what would you do differently? Leave a comment below.