(7) Small eye...big problem

To present a complex case of a hyper mature cataract in a learning disabled patient where a primary posterior curvilinear capsulorhexis was indicated. This was a complex case with the following complicating factors: hyper mature cataract, microphthalmic eye, corneal opacification, and fibrosed capsule. Primary posterior capsulorhexis was indicated due to predicted impossibility of carrying out YAG laser capsulotomy on this patient in the future due to learning disability. Pre-existing capsular fibrosis made the posterior capsulorhexis more difficult and resulted in an larger than desired posterior opening. Attempt to insert a one piece lens into the bag was unsuccessful due to posterior direction of the leading haptic into the vitreous cavity. This necessitated IOL exchange with a 3 piece intraocular lens with haptic in the sulcus and optic captured in the bag.