This patient has severe pseudo-exfoliation with almost zero capsular support. When the surgeon attempts to start the capsulorhexis, the entire cataract (including the capsular bag) rotates extensively. You can tell from the pic above that our guest surgeon elected to use capsular/iris hooks to support the capsule and then perform phaco. Braver than me — I would have likely switched to MSICS and done an intra-cap surgery. How would you approach this case? What about IOL fixation? Our guest surgeon does a great job.
