Operating on the Edge: Surviving Cataract Surgery in Post-AACG Zonular Disaster

曾垂鍊 Chui-Lien TsenTaiwan Speaker Operating on the Edge: Surviving Cataract Surgery in Post-AACG Zonular DisasterThis video demonstrates the surgical management of a mature cataract in an eye with a history of acute angle-closure glaucoma (AACG) complicated by zonular dialysis. The procedure highlights key steps for anterior chamber stabilization, controlled capsulorhexis under shallow conditions, and safe nucleus removal using phaco techniques. Intraoperative support with capsular tension ring and viscoelastic-assisted chamber maintenance was critical to preserving capsular integrity. Despite severe zonular weakness, careful pacing and early mechanical stabilization allowed successful in-the-bag intraocular lens implantation with minimal intraoperative complications. Postoperative recovery was stable with good visual outcome. Cataract surgery after AACG with zonular compromise remains one of the most technically demanding situations in anterior segment surgery. This case illustrates that with meticulous fluidic control, supportive devices, and adaptive strategy, even a “zonular disaster” can end with a safe and satisfying surgical result.