This is a very tough case of a traumatic cataract with zonular loss and vitreous prolapse into the anterior chamber. Initial steps include staining the vitreous with triamcinolone and then and using a high-viscosity ophthalmic viscosurgical device (OVD) to stabilize the anterior chamber and tamponade vitreous. Capsular support can be achieved with capsule hooks or a capsular tension ring, depending on the extent of zonular loss. If vitreous is present in the anterior chamber, a limited anterior vitrectomy must be performed to clear the visual axis and prevent traction on the retina. Phacoemulsification should be performed with low flow and vacuum settings to minimize stress on the remaining zonules. Gentle technique and proper support are essential to avoid complications such as retinal detachment, cystoid macular edema, or IOL dislocation. Great job on this tough case!
