Cataract-implant surgery was performed in a very highly myopic young woman with several disabilities, retinopathy of prematurity and an extremely dense cataract with an appearance that resembles spherophakia. Phacoemulsification, insertion of capsule retractors, a capsular tension ring and a 40 diopter IOL were done in a necessarily deliberate manner. General anesthesia was avoided by the reassuring support of the patient's mother who accompanied the patient into the operating room and maintained constant contact with her throughout the operation. Both the appearance of the cataract and logistics of the procedure are rare.
Pseudoexfoliation, zonular laxity, poor dilation, a shallow anterior chamber and a convex anterior capsule are all present in this 85 year old patient.