Weak zonular support makes cataract surgery far more challenging and increases the potential risks such as vitreous prolapse, retained lens material, dislocation of the IOL and the need for more surgery.
With some cases of traumatic zonular damage, we can see phacodonesis during the preoperative exam with the entire cataractous lens moving as the patient changes gaze. However, if the zonular damage is primarily in one quadrant, there may not be any signs of zonular weakness until the time of surgery. In the case presented here, the surgeon did not realize the extent of zonular weakness until