This surgical video demonstrates the management of a hyper-mature cataract with zonular insufficiency in the left eye of a 69-year-old male with a history of glaucoma. Preoperative examination revealed vision limited to count fingers, advanced lens opacity, and an absent fundus view in the left eye. Intraoperatively, iris retractors were used for poor pupillary dilation, and trypan blue aided visualization in the absence of red reflex. Following aspiration of liquefied cortex, capsular bag collapse and inferior zonular loss were noted. Intracapsular cataract extraction was performed using a lens loop, followed by anterior vitrectomy and implantation of an anterior chamber intraocular lens with a Sheets glide. A second anterior vitrectomy was completed to ensure a clear visual axis. Retrospective history revealed prior blunt trauma from a baseball injury, likely contributing to the patient’s lens instability. Postoperative recovery was uncomplicated, and the patient achieved a final visual acuity of 20/50 in the left eye.
