This patient has severe pseudo-exfoliation and you can tell from the pre-operative photo that there will be extensive zonulopathy. The clues are the large degree of PXF material on the pupil margin and the anterior displacement of the cataract so that it pushes up against the back surface of the iris when the patient is at the slit lamp microscope. When the patient is supine on the operating room table then the lens-iris diaphragm gets displaced posteriorly and the anterior chamber depth increases. Clearly a warning sign. Our guest surgeon does a great job with this tough case. How would you approach this case? Please comment below.
