Steven Vold, MD, presents a middle aged woman with Irido Corneal Endothelial Syndrome (ICE) with a dense cataract. The patient has previously undergone multiple surgeries for glaucoma, including Ahmed valve implantation. Iris hooks are placed to improve exposure, iris is removed from the leathery anterior capsule. A capsular tension ring is inserted with a Geuder shooter and a can-opener capsulotomy is performed. Carefully maintaining a stable anterior chamber, slow motion phaco is used with minimal rotation of the lens in order to preserve zonules.