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Ophthalmic Consultants of London http://www.OCLvision.com Mr Romesh Angunawela. 0203 3692020 https://www.oclvision.com/consultants... This is the surgery of a patient with a subluxated lens due to Marfan's syndrome. The lens generally moves upwards as the zonules weaken. The stretched zonules are visible in the early frames of the video. There is no significant cataract present, but the patient's vision was reduced due to increasing astigmatism and aberrations as she sees through the periphery of her natural lens. Surgery is technically challenging but completed without complication or vitreous loss. The difficulties that need to be anticipated are potential instability of the lens during surgery due to absent or weak zonules, difficulty with capsulorhexis creation due to lack of counter traction, difficult phaco position due to lens decentration, vitreous prolapse and how best to secure the new intraocular lens. Sutured lenses in younger patients may not remain secure due to suture breakage over time. Goretex sutures may be more resilient to degradation. Zonules opposite the area of suture fixation may also weaken and breakdown over time and result in late lens instability. In this case an anterior chamber lens was used. An alternative would have been an iris clipped lens.