This case outlines the phacoemulsification technique used to overcome the challenge of the hyperdeep anterior chamber, weak zonules, abnormal anterior capsule, and large capsular bag. Key steps included trypan blue staining of the anterior capsule, a large capsulorhexis, prolapse of the nucleus into the anterior chamber with phacoemulsification anterior to the capsulorhexis, and a posterior chamber-placed iris-clip intraocular lens. Successful visual rehabilitation is achievable in these anatomically challenging eyes.

A 75-year-old man had routine phacoemulsification cataract extraction with posterior chamber intraocular lens implantation in the left eye using a temporal corneal incision and inferior paracentesis. Examinations at 1 day and 1 week were unremarkable; however, at the 6-week assessment, a cilium was noted to have penetrated the external ostium of the paracentesis, with the proximal (follicle) end abutting the internal ostium of the wound. While the cilium was removed without incident, this chance finding may aid our understanding of how intraocular cilia are occasionally discovered following routine small-incision sutureless cataract surgery.

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