Rock hard cataracts are frequently accompanied by additional surgical risk factors. This is an ultrabrunescent cataract in an eye with prior angle closure glaucoma, a very crowded anterior chamber, and a fixed, small pupil. To create enough working room, a pars plana vitreous tap must be used and the pupil is dilated with a Malyugin ring. The associated significant zonulopathy must be managed with capsular retractors and then a capsular tension ring.
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This presentation is from the session "SYM-208: Sweating Bullets: A New Competition" from the 2019 ASCRS Annual Meeting held on May 4-7, 2019 in San Diego, California.