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Total Zonular Failure

This patient is in his later 60's with a dense cataract. Something unexpected happened at the end of nuclear removal that resulted in a complication and change of plan for implant. He admitted to a history of bar room fights even up to a few years before the surgery. Evidence of zonular laxity is apparent in the capsular creases that appear at the initiation of CCC, the difficulty in obtaining a good wave of hydrodissection and resistance to rotation after hydrodissection and during phaco. Postop he initially did well but returned 2 months later with herniated vitreous into the AC and CME; the CME responded well to medical therapy and no further surgical intervention was needed.