Dr. Ken Wright shares a case of persistent hyperplastic primary vitreous (PHPV) and IOL implantation. The anterior capsule shows mild fibrosis, making capsulorhexis difficult if not impossible. Dr. Wright performs an anterior capsulectomy and then aspirates the cortex. The remnant posterior vascular stalk is seen arising off the optic nerve and adhering to the posterior capsule. These stalks typically do not hemorrhage, but if they do, bleeding can tamponaded by reducing suction and increasing IOP. Dr. Wright places a 3-piece acrylic IOL in the sulcus to complete the case.