We start our 4th season with a very interesting case! My preoperative plan was to use a toric IOL in this 89 year old patient with a very dense cataract. After discovering a complete lack of zonular support, I perform a vitrectomy and change my lens choice to an AC IOL. I discuss control of the remaining astigmatism near the end of the procedure.
Pseudoexfoliation, zonular laxity, poor dilation, a shallow anterior chamber and a convex anterior capsule are all present in this 85 year old patient.