Endothelial protection is always important, though in a patient with severe corneal dystrophy and a shallow anterior chamber, it is even more critical. In this case, I discuss several pearls for safe removal of the nucleus in a patient with a severely compromised endothelium.
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.