This complex traumatic cataract case begins with the challenge of posterior synechiae, which must be lysed to visualize the underlying white cataract. Upon performing the cataract extraction, the surgeon encounters a fibrosed and scarred posterior capsule that lacks the clarity and elasticity required for a standard intraocular lens placement. This necessitates a primary posterior capsulotomy to clear the visual axis. Because the posterior capsule is compromised and opened, a partial anterior vitrectomy is performed to remove any prolapsed vitreous and ensure a stable environment. Since the capsular bag cannot safely support a lens, a three-piece intraocular lens is placed in the ciliary sulcus. The surgeon must ensure proper centration and stability of the sulcus-fixated IOL to provide a successful visual outcome despite the extensive ocular trauma. This case highlights the need for surgical flexibility and the importance of having back-up lenses available when dealing with traumatic zonular or capsular injury.
