The first thing that catches your attention in this picture is the large pterygium. And I agree that a more precise refractive approach to the cataract surgery would be to first remove the pterygium, then let the ocular surface heal up for a few months, and then perform the cataract surgery. With that said, our focus on this case is the vertical / combo chop technique which is pretty good in this case. I have some suggestions for improvement that will make this surgeon more efficient and facilitate nucleus removal.
