Cataract surgery in elderly patients is often challenging due to advanced cataract, miotic pupil, zonular weakness and other ocular or systemic co-morbidities like glaucoma, hypertension and diabetes. This video presents phacoemulsification under topical anaesthesia, in a 78 years old hypertensive gentleman, with chronic angle-closure glaucoma, grade IV nuclear sclerosis and miotic pupil. The miotic pupil was dilated using B-Hex pupillary expander. After the nucleus was emulsified, the anterior chamber (AC) became flat with repeated iris prolapse through the incision ports. Cortical aspiration became difficult. I.V Mannitol infusion was given. Cortical aspiration was attempted after 1 hour and again after 2 hours but failed. Further trial was abandoned, and the patient was left aphakic. Five days later, the AC was formed and quiet, but there was a supra-choroidal haematoma, confirmed by USG. Thus a potential expulsive haemorrhage was avoided by proper assessment and curtailing surgery.
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