In cataract surgery with severe global zonulopathy and marked phacodonesis, complete removal of the capsular bag may be necessary to ensure long-term intraocular stability and visual rehabilitation. While we can use capsule hooks (or iris hooks in a pinch) to stabilize the bag during nucleus removal, but what about final fixation? The capsular bag in this case is very easily removed with just forceps since the zonulopathy is so severe. Once the bag is removed, a limited anterior vitrectomy is usually required to clear any vitreous that may have prolapsed into the anterior chamber. Intraocular lens implantation can be performed using scleral fixation techniques, such as intrascleral haptic fixation or sutured posterior chamber lenses. Careful wound construction, meticulous vitreous management, and postoperative monitoring are essential to optimize outcomes.
