Our guest surgeon does a great job of managing surprise zonulopathy encountered during cataract surgery in this monocular patient. Discovering focal zonulopathy during cortical removal requires immediate recognition and a strategic, gentle response. Typically, the first sign is asymmetric capsular movement or seeing the capsular bag equator when the I/A tip engages the cortex. Stop aspiration immediately and inject a dispersive ophthalmic viscosurgical device (OVD) to stabilize the capsular bag and maintain chamber depth. Avoid pulling toward the area of weakness and instead, switch to tangential or centripetal stripping motions from the opposite quadrant. If the bag shows persistent instability, consider placing a capsular hook to support the zonular defect. Cortex overlying the weak area can be left temporarily while the remaining cortex is removed safely. Once the bag is cleared, reassess zonular integrity; a capsular tension ring can be inserted to address the dialysis. The key is to minimize traction on compromised zonules, preserve capsular integrity, and maintain safe intraocular lens support.
