Operating in an eye with a history of angle closure and a shallow anterior chamber presents a significant crowded environment. The primary objective is to create and maintain working space while protecting the corneal endothelium and iris. Begin by using a high-viscosity cohesive OVD to deepen the chamber and push the iris-lens diaphragm posteriorly. If the space remains critically shallow, a iris-retractor or specific OVD maneuvers can help gain room. The capsulorhexis is tougher to perform and you may get a run-out (like in this case). During phacoemulsification, keep the phaco tip as deep as possible, near the iris plane, to avoid thermal or mechanical injury to the eye. Use lower flow rates and vacuum settings to minimize turbulence in the constricted space. A prompt IOL implantation usually resolves the narrow-angle anatomy, permanently opening the drainage system. Pseudophakia is a gift for these eyes!
