Severe zonulopathy with marked phacodonesis requires early mechanical stabilization of the capsular bag to permit safe cataract surgery. After creating a well-centered capsulorhexis, the first step is to anchor the bag with capsular hooks (or iris hooks) then a capsular tension ring can be placed in the capsular bag for further support. After nucleus and cortex removal two capsular tension segments (CTS) are fixated with 6-0 polypropylene suture can be passed through the eyelet of the CTS and externalized through the sclera in a trans-scleral fixation pattern. Instead of tying knots, low-profile flanges are created by gently melting the suture ends with low-temperature cautery and burying them beneath the scleral surface. With both segments fixated, the capsular bag remains stable enough accommodate an in-the-bag IOL (including a toric IOL like in this case) with excellent long-term centration. Beautiful case!
Why did the surgeon used the iris hooks first and only then switched to capsular hooks?
Also, before the switch- did he perform hydro-dissection or did he use more OVD?