A young doctor in training asked me to put together a list of key videos prior to her first day…
1179: how to properly insert an AC IOL
One day you will certainly need to know how to insert an AC IOL. Note that these types of IOLs…
1178: AC IOL orientation & calculations
Anterior chamber IOLs (AC IOLs) are not often used, but there will be a time where just about every cataract…
1177: what is this red reflex crescent?
This patient is undergoing cataract surgery and as soon as you insert the phaco probe into the eye, you notice…
1176: cataract surgery in Fuchs’ dystrophy
You will certainly encounter patients with Fuchs’ dystrophy where the corneal endothelial cell layer becomes compromised. With loss of endothelial…
1175: the last case of residency
This is the final cataract case that was performed during residency and likely represents about 200 to 300 cataract surgeries…
1174: picking the right IOL for each eye
We are fortunate to have a wide range of different IOLs to offer our patients. We have bifocal IOLs, trifocal…
1173: phaco aspiration of lens milk
Intumescent white cataracts can pose a problem with capsulorhexis creation. This is because the cortex has liquefied and pressurized the…
1172: anterior capsular tear in phaco
The lens capsular bag is fragile and very thin, with an anterior measurement of about 14 microns and a posterior…
1171: pigment dispersion syndrome
Pigment dispersion syndrome is a condition where iris pigment is dispersed throughout the anterior segment of the eye via the…
1170: sealing of paired phaco incisions
Using paired full-thickness incisions to treat corneal astigmatism is an established technique that has been used for many decades. We…
1169: surgery for a cataract surgeon
It is always a pleasure to do cataract surgery for a fellow cataract surgeon. This is the highest compliment that…
1168: rescue this descemet’s detachment
Descemet’s membrane is very delicate and it can become detached during surgery. The usual entry site is from one of…
1167: resident graduation lecture
I was honored to speak at the residency graduation annual seminar for the Jones Eye Institute at the University of…
1166: learn the phaco flip technique
In our Complete Cataract Case series, we present the technique of phaco flip. This is a great technique for a…
1165: routine pseudo-exfoliation case
From our Complete Cataract Case series, this is a video of a patient with pseudo-exfoliation syndrome which can make the…
1164: routine phaco chop complete case
From our Complete Cataract Case series, this is a video of a routine phaco chop case. It is not cherry…
1163: phaco behind the corneal scar
When a corneal scar limits the visualization, how can you still complete the cataract surgery in a safe manner? And…
1162: resident posterior capsule rupture
This resident experiences a posterior capsule rupture during phaco and there is still a lot of nuclear lens material in…
1161: IOL rescue suture fixation
Twenty years ago, the most common method of suturing an IOL to the sclera was using 10-0 prolene and a…
1160: capsule damage from intra-vitreal injections
The most common ophthalmic procedure that is performed is an intra-vitreal injection with more than 10 million per year in…
1159: Pre-Chopper Technique
The pre-chopper is an instrument that can be used to split a cataract prior to inserting the phaco probe. It…
1158: adjusting the red reflex
The two primary illumination sources on your microscope are coaxial and paraxial. We have previously explained the differences in the…
1157: Malyugin ring rips the lens capsule
This video shows a complication that I have never seen before: insertion of the Malyugin pupil expansion ring inadvertently rips…
1156: skill level after 100 cataract cases
July marks the beginning of the academic year here in the USA when our new residents begin their training process…
1155: dense cataract, small pupil, MIGS
This is a tough case in an 87 year old patient who has a small pupil, a dense cataract, and…
1154: posterior assisted levitation PAL
In this case the posterior capsule ruptures during hydro-dissection. With a wide open posterior capsule, the nucleus starts to descend…
1153: is femto laser phaco better?
Despite more than a decade of use and hundreds of published papers, there is still some controversy as to the potential…
1152: upside down IOL with bent haptic
You are performing cataract surgery on this patient and the case is going beautifully. You made a perfect 5 mm…
1151: white cataract and uveitis synechiae
This patient has a long standing history of uveitis which has resulted in synechiae between the iris and the anterior…
1150: white cataract with iridoplasty
This patient was undergoing cataract surgery by a novice surgeon who ran into trouble right at the beginning of the…
1149: posterior capsulorhexis technique
There are times when it is helpful to perform a posterior capsulorhexis. This is a tricky maneuver because it opens…
1148: surgical skills at case 2000
This is a routine case performed by a surgeon who has done 2000 cataract surgeries. The technique here is excellent…
1147: white cataract & damaged IOL
This intumescent white cataract case becomes even more challenging when the IOL was misloaded by the surgical tech and the…
1146: the future of IOL calculations
This video features the keynote lecture that John Ladas, MD, PhD gave at the UCLA Jules Stein Eye Institute annual…
1145: white cataract anterior capsule tear
This patient has a dense white cataract and it is also intumescent in nature. There is sufficient pressure within the…
1144: white cataract intra-capsular surgery
Decades ago the standard cataract surgery was an intra-capsular cataract extraction. This involved making a large incision, injecting alpha chymotrypsin…
1143: why such a tiny capsulorhexis?
This is the double capsulorhexis technique which is a great choice for intumescent white cataracts. In these types of cases,…
1142: the ophthalmologist’s wife
This is a complete cataract case, shown start to finish, of a white cataract surgery performed for a patient who…
1141: white cataract with coloboma
This patient has a lens coloboma with about three clock hours of missing zonular support. This can make the surgery…
1140: IOL punch for suture fixation
There are many different techniques for suture fixation of an IOL to the sclera: Yamane, Canabrava, Gore-Tex, belt loop, and…
1139: playlist: resident complications
With July 1 just a few days away, a new class of senior residents will climb up the learning curve…
1138: my 100 year old cataract patient
This patient is 100 years old and she now has decided that she would like cataract surgery. Certainly we are…
1137: too soft to chop, so tumble it
If you know a variety of different phaco techniques, it is easy to switch gears and shift to something that…
1136: Refractive Lens Exchange Surgery
For high degrees of hyperopia in presbyopic patients, the best surgical solution is refractive lens exchange. For a younger patient,…
1135: IOL cutting for IOL exchange
Our guest surgeon is Jeff Whitman MD from Dallas, Texas, USA who shows us his technique for IOL exchange. While…
1134: Equal Opportunity or Equal Outcome?
Imagine two different doctors: Dr A and Dr B, both of whom are doing their residency training in ophthalmology. Dr…
1133: Capsule grabbed with phaco probe
Ideally, you want the tip of the phaco probe to stay in the central zone of the anterior segment and…
1132: Playlist: white cataract capsulorhexis
Performing a successful capsulorhexis is one of the biggest challenges in eyes with white cataracts, particularly intumescent white cataracts. This…
1131: Cataract Surgery in Ocular Albinism
Ocular albinism is rare, however just about every cataract surgeon will encounter at least one or two patients with this…
1130: Pupil Expansion with B-Hex Ring
If you really want to be honest with yourself, you will agree that the B-Hex pupil expansion ring is amazing.…
1129: exposed and eroding IOL sutures
The best placement of an iOL is in the capsular bag. That is the end of the story. There are…
1128: Why can’t I get the nuclear piece up?
You are ready for action. You embed the phaco probe and achieve high vacuum. You carefully place the chopper into…
1127: keeping track of surgical timing
You are the master of your own domain. The master of your own career. The master of your own life.…
1126: the IOL is stuck in the incision
When we move to smaller phaco incisions such as 2.2 mm or 2.4 mm wide, we accept that we will…
1125: Playlist: hydro-dissection
Hydro-dissection and hydro-delineation are critically important steps of cataract surgery since they allow us to carefully preserve the capsular bag…
1124: Pearls for learning MSICS
It may surprise you to know that many young ophthalmologists in the USA do not have experience performing MSICS. In…
1123: dense brunescent cataract chop
This video showcases the entire surgery which we are running at 2x speed so that it is just 5 minutes.…
1122: Remote Capsulorhexis Training
Prof. John Ferris has started a novel program of remotely teaching young surgeons to improve their surgical skills. This can…
1121: how it started… how it’s going…
There is so much to be learned from this case. The patient has advanced diabetic retinopathy and a significant cataract.…
1120: make sure the IOL is centered
We want the IOL optic and the capsulorhexis to both be centered. This is especially important for multifocal IOLs and…
1119: resident attempts a white cataract
This is case number 50 for a resident who is being supervised by a senior attending faculty member. It is…
1118: Playlist: IOL Loading
Loading the IOL into the injector cartridge is a skill that every cataract surgeon must master. In my private practice…
1117: complete list of all medications used
What medications do we typically use for routine cataract surgery? This video provides a complete list including pre-op and post-op…
1116: how to clean this scarred capsule
In this case of a dense posterior sub-capsular (PSC) cataract, there is some scarring of the posterior capsule. It is…
1115: no need to hook the lens equator
The original technique of phaco chop involved placing the chopper under the capsulorhexis edge and then around the lens equator.…
1114: success with young cataract patients
When we are operating on a younger cataract patients, the stakes are higher and the surgery must last the patient…
1113: surgery center OR block time
Welcome to another Monday morning from my operating room (OR) at our Beverly Hills surgery center. We are discussing surgery…
1112: surgical pearls for ocular asymmetry
While most patients have eyes that are very similar, there are a few patients where the eyes are remarkably different,…
1111: Playlist: Surgical Learning
All great surgeons are students for life: continually learning and evolving surgical techniques to keep up with the latest techniques…
1110: more chops for a dense nucleus
If the cataract nucleus is more dense, such as 3-4+ NS, performing more chops is beneficial to break up the…
1109: the mushy nucleus is tough to chop
Sometimes when we try to chop the nucleus, we realize that the cataract material is too mushy and the chopped…
1108: Moderate Nuclear Density Chop
I am often asked why I just do the one chop in some of my cataract cases. Would it be…
1107: IOL exchange of very unusual IOLs
Master surgeon Dr. Val Apostolov from Amsterdams shares with us some unusual cases. These are both IOL exchange surgeries for…
1106: thick cortex / epi-nucleus remains
In cases with insufficient hydro-dissection, we can be left with a thick cortex and epi-nuclear shell after performing hydro-delineation. How…
1105: Using the Power Pre-Chopper
The Ultra-chopper was designed by Dr Luis Escaf in order to penetrate a very dense nucleus to chop a cataract.…
1104: Playlist: Post-Op Day 1
Modern day cataract surgery has a very high success and safety record, with the vast majority of patients having a…
1103: Pre-Chopper Technique
Pre-chopping means that we are splitting the nucleus into half or quadrants prior to inserting the phaco probe into the…
1102: capsule rupture with the IA probe
A posterior capsule rupture can happen at any time during cataract surgery and in this case it is right at…
1101: Infant Lensectomy Technique
While congenital cataracts are rare, they must be identified very early in an infant’s life and then often surgically treated.…
1100: Very soft PSC cataract technique
This patient is young, under age 40, and has been suffering from posterior subcapsular cataracts for more than 1 year.…
1099: some amazing surgical pearls
With CataractCoach, I am sharing everything that I have learned or figured out during the past 25 years in ophthalmology.…
1098: Quad Camera Angles in surgery
This video was sent to us from Dr Felipe Ribeiro and Dr Andre Berger from Brazil and it features the…
1097: Playlist: Suturing
While most routine phaco cataract surgeries do not require sutures for closure of the incision, the ability to suture is…
1096: converting from phaco to ECCE
There are rare times when it becomes important to convert from phaco to manual extra-capsular cataract extraction. This is one…
1095: Where to place the chopper
Let’s admit that phaco chop can be a tough technique to learn. It requires both hands to perform a different…
1094: The Key to Phaco Flip & Chop
Flip and chop is a great phaco technique for a lens nucleus of moderate density. In a very safe and…
1093: Audience Poll: Pupil Ring or Not?
This is the maximum pharmacologic dilation of about 4mm and the patient is noted to be taking tamsulosin (Flomax) for…
1092: Traumatic Cataract Zonular Loss
Our guest surgeon Dr Vipul Arora from India presents a case of a traumatic cataract with sectoral zonular loss. This…
1091: Dense Cataract and Nystagmus
Our guest surgeon is Dr Érico Jun Oda from Brazil and he demonstrates an expert level cataract surgery in a…
1090: Playlist: Patient Experience
The patient experience is a critical part of your surgical practice. The patient wants a pleasant experience with good communication…
1089: Try the CataractCoach Challenge
Take the CataractCoach challenge: perform a cataract surgery while keeping the light reflex (Purkinje image) in the central zone of…
1088: Recent residency graduate critique
This video was submitted by an ophthalmologist who recently graduated from residency training. He has about 350 phaco cases of…
1087: how to perfect your case
In this complete cataract case, we are going to slow it down a bit and show you the subtleties that…
1086: Do you get nervous or anxious?
I will be the first person to tell you that performing ocular surgery is stressful and not easy. We are…
1085: Zero power IOL for ultra myopia
Welcome to my operating room at our Beverly Hills surgery center. In this video we will discuss cataract surgery in…
1084: toric planning for high astigmatism
Our video today showcases the surgical planning for this patient with a high degree of corneal astigmatism. We will go…
1083: Playlist: Divide-and-Conquer
Divide and conquer is a popular technique of nucleus removal during cataract surgery and it is usually the first technique…
1082: release of posterior synechiae
Our guest surgeon shows us his technique of using a spatula to release the posterior synechiae in this eye with…
1081: if you need iris hooks, use them
Our guest surgeon shows us a case that really benefits from using iris hooks. This video goes into the details…
1080: phaco tip punctures the capsule
This anonymously submitted video shows a complication that can happen to any of us. This patient had a white cataract…
1079: you must learn SICS / ECCE
More than 20 years ago when I was a resident ophthalmologist at the UCLA Jules Stein Eye Institute, we performed…
1078: Cataract Quiz – you see this post-op
You did surgery for this patient yesterday and she is so happy with 20/30 vision today. She started with a…
1077: traumatic cataract & pupilloplasty
This patient sustained blunt trauma to his eye and then developed chronic mydriasis and a cataract with significant zonular loss.…
1076: Playlist: Viscoelastics / OVD
The use of viscoelastics transformed cataract surgery decades ago. We use the viscoelastic to protect delicate tissues like the corneal…
1075: Can I use EDOF with eye disease?
I am frequently asked if the new class of EDOF (extended depth of focus) IOLs can be used in eyes…
1074: Angle sweep at the end of phaco
While we need viscoelastic to perform a safe cataract surgery, we do not typically want to leave this OVD inside…
1073: Why did the AC Depth increase?
This patient had biometry performed in our clinic, using the same machine in 2017 and then again in 2021. Of…
1072: epi-nucleus removal technique
In cases where we perform hydro-delineation and we have a separate epi-nuclear shell to remove, what is the best technique.…
1071: Challenging Phaco + DMEK
Prof. Dr. Martin Dirisamer from Munich, Germany is a recognized expert in DMEK surgery and he presents a challenging case…
1070: Posterior Polar Cortical Cleaving
I really enjoy watching surgical videos from Dr. Neto Rosatelli from Ribeirão Preto, Brazil because he mixes his high degree…
1069: Playlist: Astigmatism
Cataract surgery is designed to correct the cataract. Refractive cataract surgery is to correct the cataract and also the refractive…
1068: sutured capsular tension segment
This patient was born with a lens coloboma where part of the crystalline lens did not develop and there is…
1067: Phaco and iStent Glaucoma device
Cataract surgery alone tends to lower intra-ocular pressure by as much as 25%, which is particularly helpful for patients with…
1066: senior resident stop-and-chop
This cataract surgery is being performed by a senior resident in the USA (PGY-4 level which means post-graduate year number…
1065: Cortical Cleaving hydro-dissection
Cortical cleaving hydro-dissection was described 30 years ago by Howard Fine MD, a pioneer in the shift to modern day…
1064: lessons from 1 year of COVID-10
Just more than a year ago, we had a nationwide shutdown to attempt to curb the spread of COVID-19. This…
1063: Who is the ideal trifocal patient?
Of course, it goes without saying that you must have a normal cornea, retina, and optic nerve to even be…
1062: Playlist: Refractive Issues
The most powerful refractive surgery that we have is cataract surgery. We can address +10 diopters or more of hyperopia,…
1061: soft cataracts the easy way
It would seem that performing cataract surgery on an eye with a soft cataract would be easier. Since there is…
1060: Quiz: Why is this so adherent?
Another Cataract Quiz: the case seemed totally normal and without any issues. The IOL is in the capsular bag and…
1059: Quiz: the case is not done yet
The answer to this Cataract Quiz is seen in the photo above. Look carefully – what do you notice? The…
1058: Quiz: Why did the IOL decenter?
Time for a Cataract Quiz and it features a case sent to us by Dr. Valentin Bachet from Lille, France.…
1057: Resident Double Capsulorhexis
The idea behind the double capsulorhexis is to avoid the capsule run-out (Argentinian Flag Sign) for intumescent white cataracts that…
1056: Let’s talk about my OR cases
Recently, on my usual Beverly Hills cataract surgery day, I had a line-up of a bunch of interesting cases and…
1055: Playlist: Posterior Polar Cataracts
Studies have shown that 1 out of 3 posterior polar cataract surgeries result in a ruptured posterior capsule. Here’s the…
1054: complete case: why we chop
You know that I’m a big fan of the phaco chop technique for nucleus disassembly during cataract surgery because it…
1053: that’s not cortex you’re pulling!
In this anonymously submitted video, we see that if the capsule is inadvertently grabbed by the suction from the I/A…
1052: Spiral Out Capsulorhexis
Our video features a young and talented surgeon, Dr Priyanka Pantola from Kanpur, UP, India and she is showing us…
1051: Fixing the Upside Down IOL
When we inject an IOL, we must ensure that it goes into the eye (either in the capsular bag or…
1050: complete case: Toric EDOF IOL
This patient is a young man, in his 40s, with a history of cataract development over the last few years.…
1049: four flanged IOL suture fixation
We have seen a lot of innovation with regards to IOL fixation to the sclera. There is the Yamane technique…
1048: Playlist: Phaco Efficiency
We have said it many times before, but it still bears repeating: the goal of the surgery is not speed,…
1047: Complete Cataract Case & Quiz
You start to perform the capsulorhexis and then you notice these wrinkles of the anterior lens capsule. How should you…
1046: fixing anterior capsule fibrosis
Our usual way of dealing with fibrosis of the anterior lens capsule is to use a sharp instrument such as…
1045: suturing the IOL to the CTR
Our guest surgeon is Dr. Val Apostolov from Amsterdam and he demonstrates a technique that I have never seen before:…
1044: sutured capsule support device
Our guest surgeon is Dr. Atul Khadane from Amravati, India and he demonstrates the use of the Assianchor (developed by…
1043: intra-vitreal injection punctures lens
The most commonly performed ocular invasive procedure performed in the USA is the intra-vitreal injection, with many millions done per…
1042: you must practice suturing!
If more than 99% of my cataract surgery cases do not require a suture, then why is it so important…
1041: Playlist: Anterior Vitrectomy
Face the truth: every cataract surgeon encounters an intra-operative complication where an anterior vitrectomy is needed to complete the case.…
1040: White Cataract Double Rhexis
Our guest surgeon is Dr. Manbir Singh from India and he is showing us a dense white cataract case with…
1039: complete case: surgeon control
This is a complete cataract case, shown from start to finish, with me as the surgeon. While many of the…
1038: Recurrent Pterygium Surgery
Removing a pterygium from a virgin eye that has not had prior surgery is relatively straightforward. The pterygium can be…
1037: Trifocal IOL with white cataract
Trifocal IOLs require refractive accuracy. We need to be able to deliver close to a plano outcome without much residual…
1036: How to prepare Triamcinolone
Triamcinolone is a longer-acting steroid that is very useful for intra-ocular surgery. We can use it to modulate inflammation, to…
1035: First year in practice cataract
In keeping with our theme of learning from the cataract surgeries of young surgeons who are at the beginning of…
1034: Playlist: IntraOp OCT Scan
The intra-operative OCT scan is a rarity in ophthalmic operating rooms because of its cost which can add $60,000 to…
1033: USA resident’s first phaco chop
This video shows a resident surgeon’s first phaco chop. The key is that the resident is putting the effort to…
1032: Portugal resident’s first phaco chop
This video shows a resident surgeon’s first phaco chop. The key is that the resident is putting the effort to…
1031: resident phaco chop critique
Our video is from an anonymous resident surgeon in The Philippines who is performing a phaco chop variant during this…
1030: Your Surgical Skills at Case 300
Where should your surgical skills be after 300 cases? We have previously explained the learning curve for cataract surgery and…