This is an usual case where there are zonular fibers which are centrally attached onto the anterior lens capsule, so close to the center that the capsulorhexis hits and gets stuck at these points. This is a rare case and our guest surgeon does a great job of conquering this challenging case. I especially like his technique of injecting viscoelastic with the left hand as the right hand does needle aspiration of liquefied lens cortex to safely decompress the capsular bag. Have you seen centrally attached zonular fibers like this before? Comment below.
This is a condition called Long Anterior Zonules and it is associated with African American race (seen in about 1.8% of Af/Am according to one study ) and a higher incidence of glaucoma. There has also been a series associating this with retina degeneration rarely. I’ve treated these patients in two ways….first by sweeping the most anterior long zonules prior to starting the rhexis….just sweep them away with the tip of a needle a bit and then by making the rhexis a bit smaller because once you get into the zonule “jungle” it directs the tear radially and you have to do a “Little Maneuver” to get out of the “jungle”.
You can usually wipe off anterior zonules with a Sinski hook.