This is a very rare case which I have seen in less than 1 out of 1000 cataract surgeries. This patient has a small eye (20 mm axial length) and is highly hyperopic (+6 for distance vision, +8.5 for reading) with a small white-to-white and a pupil that dilates only to about 5 mm in diameter. What is highly unusual is the very anterior (and central) attachment of some of the zonular support fibers. This begs the question: How can you do the capsulorhexis like this? Leave your best suggestion in the comments below before watching the video…
Detach anterior zonular fibre with sharp 27 guage needle
These are common in late onset retinal degeneration (CTRP5/C1QTNF5) mutations.
Usual way small rhexis or maximum permissible rhexis without damaging the ccc.