This patient had cataract surgery years ago and then progressive zonulopathy, such as from pseudo-exfoliation, caused the entire capsular bag to dislocate. The capsular bag contains the CTR (capsular tension ring) as well as the IOL and it is very mobile with minimal support. The surgeon carefully brings up the capsular bag into the anterior chamber and then extracts the CTR. The IOL is then removed using the twist and out technique that we have featured here previously. For the new IOL, a Yamane technique is used but with a somewhat better approach. Instead of having the optic go back into the vitreous cavity during externalization of the haptics, the surgeon keeps the optic on top of the iris. This works beautifully and is probably the better method of doing Yamane ISHF. Great job with this tough case.