Fig. 101. Pseudoexfoliation syndrome has created lax zonular tension so that the posterior capsule tension is flaccid, which makes cortex removal incomplete and capsular vacuuming impossible. As fibrosis progressed, substantial oblique striae developed with their apex at the area of retained cortex. Such striae sometimes can create subjective oblique streaks perceived by the patient to be oriented 90 degrees from the direction of the observed striae. In some of these cases, posterior Nd:YAG capsulotomy might help reduce the streaks, but if not, IOL exchange would be made even more difficult. (Courtesy of James A. Davison, MD, Wolfe Eye Clinic, Marshalltown, IA.