Anterior capsular snap: New sign of zonular dehiscence and instability

We describe the case of a 95-year-old woman with dense nuclear sclerotic cataracts and pseudoexfoliation glaucoma. Preoperative phacodonesis was noted on slitlamp biomicroscopy. During surgery, a localized anterior capsule dehiscence occurred with visible snapping of the anterior capsule over the capsulorhexis edge. This preferential anterior zonular dehiscence occurred during the lateral separation of 2 hemisegments of nucleus; the nuclear fragments protected the equatorial and posterior zonular fibers, avoiding zonular dialysis. The case was completed without incident after recognition and management of the zonular instability. The anterior capsular snap is a new sign of intraoperative anterior zonular dehiscence. FINANCIAL DISCLOSURE: Neither author has a financial or proprietary interest in any material or method mentioned.