A young doctor in training asked me to put together a list of key videos prior to her first day…
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…
1029: First year in practice Cataract
Our guest surgeon showcases his stop-and-chop nucleo-fractis in a routine cataract surgery and his technique is excellent. He finished his…
1028: Keys to Cataract Surgery Efficiency
If you have performed fewer than 10,000 cataract surgeries, you are still in the part of the learning curve where…
1027: Playlist: Pseudo-Exfoliation
Cataract surgery in the setting of pseudo-exfolation is particularly challenging due to the structural weakness that occurs with this disease…
1026: suturing the IOL to the iris
Our guest surgeon shows us his technique for suturing an IOL to the iris in a patient with long-standing peudo-exfoliation…
1025: Soemmering’s Ring Extraction
Our guest surgeon, Dr Val Apostolov from Amsterdam, is a frequent contributor to CataractCoach and today he shows us a…
1024: SICS for uveitic cataracts
This is a case of a cataract with extensive synechiae due to prior uveitis. The eye is quiescent now, with…
1023: Foreign body capsule rupture
This patient sustained a serious ocular injury: a foreign body pierced the cornea, punctured the anterior lens capsule, and now…
1022: Suprachoroidal hemorrhage
A suprachoroidal hemorrhage is a dreaded complication that can happen with any intra-ocular surgery. We most commonly see it during…
1021: the nucleus drops during phaco
This anonymously submitted video shows a complication from a resident cataract surgery. The capsulorhexis radializes in the sub-incisional area and…
1020: Playlist: Complications
Complications happen to all surgeons, no matter how much experience we have. It is true that a surgeon who has…
1019: from one chop to the next
This complete cataract case shows how we move from the first chop to the next in order to efficiently break…
1018: the many uses of the chopper
The phaco chopper instrument does more than just chop the nucleus. We use it to pull nuclear pieces out of…
1017: complete case with dense endo-nucleus
This complete cataract cases features a younger patient who developed bilateral cataracts with a dense endo-nucleus. We also implant a…
1016: flip and chop in high myopia
This is a patient with a large degree of myopia and a relatively dense cataract. And it is a good…
1015: phaco flip + chop in pseudo-exfoliation
This complete cataract case features an elderly patient with a dense cataract and pseudo-exfoliation. We use the flip and chop…
1014: Cataract after prior vitrectomy
This week we are doing complete cataract cases where we will show an entire surgery from start to finish and…
1013: Playlist: Glaucoma Cases
The most commonly performed glaucoma surgery is…. cataract surgery! We know that doing cataract surgery alone can lower intra-ocular pressure…
1012: Resident White Cataract Chop
The drive to continually improve our surgical skills starts in residency and then continues for the rest of our careers.…
1011: Opacified IOL Exchange
While it is rare, some IOLs can become opacified with time. This has been reported primarily with hydrophilic acrylic materials…
1010: Bimanual Phaco Technique
About 15 years ago, bimanual phaco was relatively popular. The idea is that by separating the infusion from the aspiration,…
1009: Cutting a Fibrotic Lens Capsule
In some white cataracts, the lens capsule can become fibrotic as the lens cortex becomes absorbed and the capsule contracts.…
1008: Horizontal Chop Technique
Our guest surgeon is Dr Hafidi Zouheir from Rabat, Morocco and he expertly demonstrates the horizontal chop technique for a…
1007: IOL calculations with retinal disease
Today we present a quick review of IOL selection and calculations when performing cataract surgery on patients with retinal disease.…
1006: Playlist: Indian Surgeons
Our ophthalmology colleagues from India have brought a high degree of expertise to cataract surgery. Over the past decades, I…
1005: Resident’s first Anterior Vitrectomy
Every cataract surgeon will experience a ruptured posterior capsule and vitreous prolapse as a complication. The key is to recognize…
1004: Preventing Capsular Rip in white cataracts
This 30 year old patient has a tough situation: bilateral white cataracts with high pressure within the capsular bag. There…
1003: Why did the patient go elsewhere?
This video shows two complete surgeries, both presented at high speed. The original cataract surgery was performed by me and…
1002: Do not upset the iris!
There is a lot to learn from this resident cataract surgery. The case starts out with a reasonable pupil of…
1001: Ahmed Glaucoma Valve Technique
Our guest surgeon today is Victoria Tseng, MD, PhD who is a glaucoma specialist and professor at the Jules Stein…
1000 posts/videos on CataractCoach
Back in May of 2018, I had the idea to start CataractCoach.com where I would routinely post about cataract surgery,…
999: Playlist: Toric IOLs
For the correction of astigmatism at the time of cataract surgery, toric IOLs can be an excellent option. The best…
I wish I had this book in residency!
“What your medical school and ophthalmology textbooks can’t teach you, but what your mentors, colleagues, and patients will!” That really…
Capsular Tension Ring Placement
Our guest surgeon is Dr. Bhagyashri Deshmukh from Amravati, India and she is presenting a traumatic cataract case with a…
iris claw lens to address aphakia
Another excellent video from our colleague Dr. Val Apostolov from Amsterdam. In this case there is a patient with a…
highly myopic cataract surgery
These are some of the most rewarding cataract surgeries to perform since we can correct the cataract as well as…
considerations for monocular patients
Monocular patients present a special situation that can differ from a routine case in a patient with two eyes. We…
white cataract needle decompression
This patient is a good candidate for needle decompression because the intumescent cataract has a distinct fluid layer and we…
Playlist: Brazilian Surgeons
The first time I went to Brazil, it was an amazing experience because of the passion. And this applies to…
Anterior Chamber Phakic IOL removal
Phakic IOLs are useful to address extreme degrees of myopia, but there are potential complications. Previously, we have featured cases…
Routine Cataract Case for Myopic Patient
Complete Cataract Case: the entire surgery is shown from start to finish, but don’t fret, it is still just a…
Cataract with Silicone Oil Removal
Our guest surgeon is Willie Kan, MBBS from Malaysia and he is showing the technique of combined cataract surgery with…
Simplified Pre-Chop Technique
The pre-chop technique refers to mechanically breaking the nucleus into smaller pieces prior to inserting the phaco probe into the…
Pseudo-Exfoliation White Cataract
Our guest surgeon today is a young ophthalmologist from Spain and he is performing phaco for a patient with a…
Four handed phaco! What?
This is a case where we knew ahead of time there would be issues. The patient is mid 50s in…
Playlist: Hiding in plain sight
There are so many subtle clues in cataract surgery that can easily be missed, particularly when less experienced surgeons are…
Descemet’s Membrane Detachment
When we make a corneal incision for cataract surgery, we must be careful to avoid damaging the attachment of Descemet’s…
Cataract, cornea transplant, glaucoma tube
Our guest surgeon is Guillermo Amescua MD who is a faculty member at the Bascom Palmer Eye Institute in Miami.…
The critical step after the chop
There is a critical step after the chop that is absolutely required to facilitate nucleus removal. And this step is…
Cataract Quiz: First eye predicts the next
This patient had cataract surgery in the first eye a few years ago and when we look at the undilated…
Recovering from an anterior capsule rip
We have extensively covered the topic of white cataracts here on CataractCoach and we have an entire subcategory devoted to…
Recovering from misloaded IOLs
We count on our surgical techs and assistants to help with certain parts of the cataract surgery. One of these…
Playlist: toughest cases of 2020
After reviewing the surgical cases from 2020, I have chosen four tough cases to present here. Two of the cases…
Soft Chop technique for soft cataracts
With the amazing results from modern day cataract surgery, many patients are electing to experience the benefits of pseudophakia when…
Extended Depth of Focus: Alcon Vivity
We all want to be young again, at least when it comes to vision: visual quality, range of vision, and…
Cataract Quiz: Zonular Dehiscence
Our guest surgeon is Dr Willie Kan from Malaysia and he presents a very tough case: a traumatic white cataract…
Severe Zonular Laxity in PXF Cataracts
This is a really difficult surgery and we know that ahead of time. When we examine this patient at the…
Never make an incision like this!
This is a resident case where the incision has terrible construction. The primary mistake is gliding the keratome along the…
chandelier lighting for cataract surgery
This patient has a non-clearing vitreous hemorrhage from proliferative diabetic retinopathy in addition to a cortical cataract. Our guest surgeon…
Playlist: Critical Life Lessons
Let’s start the new year right and make 2021 the time where you advance your surgical skills. Certainly dexterity and…
refractive lens exchange for hyperopia
This 58 year old patient is highly hyperopic, wearing +8.5 D glasses for distance vision and then +11.0 D glasses…
Top CataractCoach videos of 2020
As the year comes to an end, we have succeeded in making a new CataractCoach video/post for every day of…
complete cataract case: optimize steps
Most of us will have the opportunity to perform thousands of cataract surgeries (often tens of thousands) during the course…
clean your optics & focus the microscope
This is actually a very important lesson. Your microscope optics will determine your view for the surgery and that could…
complete case: chop nucleus in the bag
One of my favorite types of videos to watch is the Complete Cataract Case. I enjoy seeing a surgery from…
IOL design differences
We have many different IOL designs available for use in cataract surgery and even within the most popular category (single-piece,…
Playlist: Capsulorhexis
The capsulorhexis is an important step of cataract surgery. It allows us to maintain the strength of the capsular bag…
anterior segment total reconstruction
This is a very complex case of a patient who had cataract surgery elsewhere and sustained complications during the procedure.…
double flange IOL scleral fixation
The Yamane technique of IOL fixation to the scleral works better with certain three-piece IOLs because of the differences in…
management of a dropped nucleus
This is a rare complication that can happen to any patient so the surgeon must know how to effectively manage…
Capsule Break with I/A and rescue
Our guest surgeon today is Dr Ahmed Al Habash who shows us the best technique of dealing with a posterior…
Punctured Posterior Capsule Rescue
There are two types of ophthalmologists who do not ever have surgical complications: those who do not operate and those…
Ruptured Posterior Capsule Recovery
This patient had uneventful cataract surgery in the first eye with placement of a toric trifocal IOL in the capsular…
Playlist: Traumatic Cataract
The eye is a delicate organ and trauma can cause many challenges during cataract surgery. The more common issues include…
Guest surgeon: Milky White Cataract
Our guest surgeon today is Dr Pooja Bhomaj from Miraj, India and she presents a case of a milky white…
This subtle sign indicates weak zonules!
This is a very subtle sign — looking at this title pic, we see a demarcation line just inside the…
Double Phaco Incisions to fix Astigmatism
double phaco incisions for treatment of astigmatism
Benchmark: Skills after 1000 surgeries
Our guest surgeon today is Érico Jun Oda MD from Brazil and he is showing us a routine cataract case.…
This sign means I need a pupil ring
this sign means that I need a pupil ring for cataract surgery
You don’t always need rings or iris hooks
For a case like this, there is no need for a pupil expansion ring or iris hooks. These devices can…
Playlist: Iris Prolapse
Iris prolapse is a relatively common issue in cataract surgery and its management is critical to the success of the…
Complicated Radial Keratotomy Case
This is a tough case where the patient had prior 16-cut radial keratotomy for treatment of a high degree of…
Femtosecond Laser White Cataract
Our guest surgeon today is Xiongfei Liu MD from Sacramento, California. He was previously a resident with us at our…
Complete Case: Pseudo-Exfoliation
Time for a complete cataract case, shown from start to finish. This patient has significant pseudo-exfoliation syndrome with all of…
Phaco tip bevel down for chop
Many viewers of CataractCoach.com ask me why I prefer to have the phaco tip bevel down for cataract surgery. The…
Secret to Chopping a Soft Cataract
If the cataract has a minimal amount of nuclear sclerosis, it is more challenging to chop it. The nucleus is…
Why be afraid of cataract surgery?
why are patients afraid of cataract surgery?
Playlist: Phaco Incisions
The phaco incision is a critical part of the cataract surgery. A great incision is the mark of an accomplished…
Patient moving during cataract surgery
Many patients ask us what will happen if they move during cataract surgery. What if they need to sneeze or…
PanOptix IOL in a Highly Myopic Patient
most extreme PanOptix IOL power for extreme myopia
Fixing IOL-induced UGH Syndrome
UGH syndrome is the triad of uveitis, glaucoma, and hyphema which all can be induced as a complication from sulcus…
Combined Phaco + DMEK Surgery
Descemet Membrane Endothelial Keratoplasty (DMEK) has become the preferred surgical technique for the treatment of Fuchs’ corneal dystrophy. In the…
Cataract Quiz: Why did this happen?
Looking at this picture, the pupil dilation went from 5 mm in diameter to 10 mm in diameter in just…
Rock the Nucleus in White Cataracts
The topic of white cataracts is so popular here on CataractCoach that we have an entire category devoted to it…
Playlist: Complete Cataract Cases
There is so much to be learned by watching a complete surgery, from start to finish. These complete cataract cases…
Twist and Out to Explant IOLs
I first saw Jack Chapman MD explain his technique to explant an IOL at a large ophthalmology meeting about 10…
Fixing a Dislocated IOL
This patient had cataract surgery done elsewhere and now seeks your help for a sub-optimal outcome in the one eye.…
Complete Case: Propagate the Chop
Another video in our Complete Cataract Case series where we show you an entire surgery from start to finish. This…
MSICS in Pseudo-Exfoliation
It is important to learn how to perform MSICS: manual small incision cataract surgery. This is a more evolved and…
Cataract Quiz: Why did the trypan do this?
Cataract Quiz: Why did the trypan blue dye do this? Why is the staining so odd looking? Why is the…
How to dissect the IOL out of the bag
When we are doing an IOL exchange, the first step is to carefully dissect the old IOL out of the…
Playlist: Small Pupil Cataract Surgery
Small pupil cases are relatively common, so all cataract surgeons must learn to master the techniques for these cases. This…