Alan N. Carlson, M.D., Professor of Ophthalmology and Chief of the Corneal and Refractive Surgery Service at the Duke Eye Center, Durham, NC demonstrates the surgical techniques that safely address cataract surgery in a complex patient. This particular patient has congenital nystagmus which had to be addressed with sufficient anesthesia block. The iris and lens defects are congenital resulting in a decentered and unstable cataract. Generous use of a viscoelastic and converting the cortical cleaving hydrodissection wave into a hydroexpression wave was the key here in the absence of capsular supporting hooks or a Cionni sutured ring. The poor zonular support necessitated use of an endocapsular tension ring and converting from a plate design to a loop design lens (IOL). This video may be viewed directly below or at the following Link.