This is a complete cataract case, shown start to finish, where the anterior lens capsule wrinkles upon attempted puncture for starting the capsulorhexis. I could have used a sharp needle or cystotome instead and it would have an easier time piercing the lens capsule, but then I would not be able to gauge the degree of zonular laxity. While the capsule wrinkles during the puncture, it does not wrinkle during the tearing of the capsulorhexis and that is a good sign. While there is some zonulopathy in this case, using a capsular tension ring is not required and I anticipate that the patient will have a stable IOL for the rest of his life. Before watching the video, what would be your technique of nucleus removal?
