We all love performing cataract surgery on average eyes because we know what to expect: an average IOL power, average dilation, average nuclear density, average AC depth, and more. A large, myopic eye has some challenges but at least there is plenty of room within the deep anterior chamber. These tiny nanophthalmic eyes prove to have most challenges: a shallow anterior chamber, poor dilation, and a very high power IOL with uncertain IOL calculations. This patient also has glaucoma, a prior peripheral iridectomy, and a dense cataract. This is certainly a 10/10 challenging case. Our guest surgeon does a great job with this tough case. What are your pearls in these nanophthalmic eyes? Please comment below.