A young doctor in training asked me to put together a list of key videos prior to her first day…
Amazing Pterygium Peeling Technique
After more than 20 years of doing ocular surgery, there are only a few surgical pearls that amaze and surprise…
Small Capsulorhexis Phaco Chop
The capsulorhexis is an important part of cataract surgery and one reason is that it allows access to the inside…
Not all white cataracts are the same
All white cataracts are not the same. They can run the spectrum from soft to very dense, with a variable…
Incisional Techniques for Astigmatism
Cataract surgery can be our most powerful refractive surgery procedure, correcting high degrees of myopia, hyperopia, and even astigmatism (with…
Review: Uveitis, Glaucoma, Cataract
Cataract surgery in an eye with uveitic glaucoma Stepwise approach to surgical success Cataract surgery in eyes with small pupils…
Neo-vascular glaucoma Ahmed Valve FP7
When teaching our UCLA ophthalmology residents at our large county hospital, Olive View UCLA Medical Center, we encounter many patients…
expert white cataract capsulorhexis
CataractCoach has advised the beginning surgeons to improve the dexterity of the non-dominant hand and this case is a great…
a short groove is sufficient
For techniques such as stop-and-chop or divide-and-conquer, the phaco probe is used to sculpt a trench or groove in the…
Complete Cataract Case: Routine Surgery
While it is fun to watch a video of a cataract surgery that involves complicated maneuvers and difficult challenges, this…
Keep track of cortex during surgery
Even with good dilation, cortex can be hidden at the capsular bag equator. In this case, the dilation is about…
choosing refractive targets
Plano is not always the goal It would seem logical that emmetropia is the ideal refractive state of the eye.…
Review: Career Paths for Surgical Learning
The path to learning surgery is a long and challenging one. True success requires years of dedication and the passion…
Cataract Quiz: What happened here?
Our quiz features a video from Gustavo Hüning, MD, MBA from Brazil and it shows an unusual situation that happens…
Rotary Chop Technique
The key to splitting a brunescent cataract is to access the central endo-nucleus. This is the densest part of the…
posterior chamber deepens with capsule break
When the posterior chamber deepens during cataract surgery, it is usually a sign that the posterior capsule has been ruptured.…
Phaco Chop without Vacuum
It is a pleasure to watch an expert surgeon doing cataract surgery and I really enjoyed learning from Dr. Alex…
Cataract Surgery with prior Amblyopia
The most common causes of amblyopia are related to either strabismus or an untreated refractive error, particularly in one eye…
Complete Cataract Case: No pupil ring!
Another video in our series of complete cataract cases, where the entire surgery from start to finish is presented. There…
compilation video: perfecting your surgery
The difference between good and great may appear subtle to outsiders, but for ophthalmologists like us, these details are very…
recovering from Argentinian Flag Sign
We have explained in great detail the techniques that can help to prevent the dreaded Argentinian flag sign with intumescent…
Cataract Quiz: Trapped Air Bubble
We have a great learning case from Dr. Xiaogang Wang from Taiyuan, China with a surgical challenge. This patient has…
Angle Alpha and Angle Kappa with IOLs
If an IOL has zero power, such as in an extremely myopic patient, where we place it in the eye…
Drill and Chop Technique
With a dense cataract, more effort and force is needed to chop the cataract. Usually with phaco chop, it is…
Surprise! Loose Zonular Support!
This patient has a dense cataract and a surprise waiting for the surgeon: as the nucleus is being cracked, we…
lift the iris in smaller pupil cases
While we think that an 8 mm pupil is very well dilated, we must remember that the capsular bag has…
compilation video: IOL exchange
Every cataract surgeon needs to learn how to perform an IOL exchange because, although it is rare, we sometimes need…
Corneal Phaco Incision Hydration
The technique of corneal stromal hydration to help seal a phaco incision is useful to ensure a watertight incision and…
Cataract surgery & decentered LASIK flap
We frequently have patients with a history of prior LASIK who are now undergoing cataract surgery. We have explained in…
complete cataract case: great red reflex
We all love a great red reflex during cataract surgery because it makes is much easier to see details such…
easily aspirating the epi-nucleus
It is much faster and easier to aspirate the epi-nucleus using the phaco probe than the I/A probe because the…
my secret for draping eyelids
It’s really not a secret, but it is critically important: you must sequester the eyelid margin and keep all eyelashes…
cannula for cortex aspiration
Bimanual irrigation/aspiration for cortex removal has an advantage: it is easy to switch hands and then access a full 360…
compilation video: suture-fixated IOLs
This video features all sorts of suture-fixation techniques for securing IOLs in cases where there is limited or no capsular…
remove one nuclear half first
There are many ways to divide and emulsify the lens nucleus in cataract surgery. Some advanced surgeons will chop the…
Cataract Quiz: many small opacities
Quiz time! You are doing what seemed like a routine cataract case and then you see many small opacities in…
scleral tunnel phaco incisions
Many years ago, incisions for cataract surgery were made in the sclera, even for the small phaco incisions. The scleral…
measure the capsulorhexis in high myopia
Eyes come in a spectrum of sizes, particularly with the measurements of the anterior segment in patients with extreme refractive…
Cataract Quiz: slight peak of pupil
This is a very subtle sign — look carefully at the picture. In the sub-incisional area, there is a slight…
recovering from posterior capsule rupture
Every surgeon, no matter how experienced, will experience complications. The rate of complications such as posterior capsule rupture declines substantially…
compilation video: dense cataracts
This compilation video features the best of many prior videos regarding dense cataract techniques. The video has many clips which…
Challenge: Monocular Dense Cataract
Operating on a monocular patient is always stressful since we know that the stakes are higher due to the patient…
Equanimity under Duress
When Sir William Osler left the University of Pennsylvania’s Medical School (the first one in the USA, started in 1765)…
Surgeon returns after a 3 month hiatus
Performing surgery at a high level is a skill that must be continually honed and practiced. What happens when we…
Glaucoma Drainage Implant Technique
I have learned so much from the video submissions that we receive at CataractCoach. It makes me wonder how I…
Complete Case: Retained Viscoelastic
Retained viscoelastic after cataract surgery is the most common reason why there is an elevation of the intra-ocular pressure (IOP)…
great learning resident cataract case
If you are in an ophthalmology residency program in the northern hemisphere, particularly in the USA, then you know that…
Compilation video: Corneal Phaco Incisions
We are starting a new feature here on CataractCoach: the compilation video, where we combine the best of many prior…
Is ophthalmology residency too difficult?
There is no doubt that ophthalmology residency training is more difficult now than it was 10 or 20 years ago.…
Resident Cataract Case with Iris Hooks
For a small pupil case, using iris hooks is helpful to give better access during cataract surgery. This case is…
Intumescent Cataract Auto Aspiration
We know that intumescent white cataracts can be challenging because the lens capsule is pressurized with liquefied lens cortex. This…
Mastering Stop-and-Chop phaco
Stop-and-chop is a common technique in phaco cataract surgery because it is safe, efficient, and relatively easy to learn. We…
Safety with Cannula Use – be careful!
Beginning surgeons do not always realize that the force created by using small 27g cannulas can be quite high. If…
Lateral Phaco Chop Technqiue
With traditional phaco chop, we place the chopper in front of the phaco probe tip, but there are other options.…
Review: Yellow versus Clear Optics
There has been much debate about the light transmission properties of various IOL optic designs. While most IOLs have a…
Make 2 Paracentesis Incisions
In the USA, most surgeons use coaxial I/A for cortex removal and as such, they tend to make a single…
Capsulorhexis Pearls
By watching many surgeons, we can learn different ways of performing the same procedure. In this case, Dr Luis Escaf…
complete cataract case: phaco flip
The key to the phaco flip technique is using the fluid wave from hydro-dissection to gently prolapse part of the…
Peeling Capsular Membranes
We present another great learning video from Dr. Val Apostolov from Amsterdam, The Netherlands to show the techniques of peeling…
Bare Sclera Pterygium Surgery
There are many ways to do the same surgery and the best option is for us to learn about all…
Setting your Phaco Speed Limit
The speed at which surgery happens during phaco is directly related to the aspiration flow rate, which is measured in…
Review: Management of Iris Prolapse
In this resident performed surgery, we encounter iris prolapse after too much hydro-dissection. This results in the iris prolapsing out…
Fibrotic Dense White Cataract
This patient developed a white cataract years ago and was unable to seek treatment for a prolonged period of time.…
Cataract Quiz: Why did the capsule rip?
This resident surgeon recently experienced quite a surprise: when he injected viscoelastic at the beginning of the surgery, the anterior…
Toric IOL for Posterior Polar Cataracts?
We know that with posterior polar cataracts, there is a congenital weakness in the posterior capsule at the site of…
Uveitic Dense White Cataract
This dense white cataract is further complicated by being an a uveitic eye with a fibrotic membrane causing a small…
Cataract Quiz: Why is the cornea cloudy?
This is a routine cataract surgery case. It is very efficient and a minimal amount of ultrasound energy is used…
Complete Case: Pressurized Cataract
This is an interesting case of a young patient, in his mid 40s, who sustained ocular trauma and developed a…
Review: 4 quadrant chop-and-conquer
Many ophthalmologists in training start out by learning the four quadrant divide-and-conquer technique, which has a long history of being a…
Resident Case: improve white cataract chop
In this anonymous video from a resident in Germany, we look to improve the horizontal chop technique in a dense…
Resident Case: improve stop-and-chop
In this anonymous video from a resident in the USA, we look to improve the stop and chop technique. This…
Resident Case: improve tilt and chop
In this anonymous video from a resident in Argentina, we look to improve the tilt and chop technique. This young…
Resident Case: improve vertical chop
In this anonymous video from a resident in India, we look to improve the vertical chop technique. This young surgeon…
Resident Case: improve horizontal chop
In this anonymous video from a registrar (resident) in the UK, we look to improve the horizontal chop technique. This…
Resident Case: improve flip and chop
In this anonymous video from a resident in South Korea, we look to improve the flip & chop technique. This…
Review: Sealing Phaco Incisions
A properly constructed phaco incision will allow good access to the anterior chamber for cataract surgery and then will seal…
climbing up the surgical skill bell curve
Learning surgery, particularly micro-surgery, is very difficult. No one is born knowing how to work within the 0.25 cubic centimeter…
traumatic cataract with bulging capsule
This 23 year old patient was involved in an accident and developed bilateral traumatic cataracts. When we examine the patient…
Critiquing my old cataract surgery video
I was digging through some old computer files and I came across an old video that I made in 2006.…
Resident recovers from capsule break
In the course of learning cataract surgery, resident ophthalmologists will encounter complications such as this posterior capsule rupture. The key…
Expert Surgeon versus The Rock
There is so much to be learned by watching other surgeons operate. Even after so many thousands of cataract surgeries…
Which resident will win this contest?
Residents often prefer to learn divide-and-conquer as the first nucleo-fractis technique for phaco surgery. This requires making a central groove…
Review: Slow Motion Phaco Chop
In the course of giving lectures across the USA and around the world, I meet many experienced ophthalmologists who find…
You must learn to do MSICS
In many countries where dense, brunescent cataracts are common, the SICS (small incision cataract surgery) or MSICS (manual small incision…
Soft cataracts can be quite difficult
Most surgeons associate dense cataracts with increasing difficulty during cataract surgery because they require more ultrasonic energy to break up…
Cataract Quiz: Use the can-opener now?
During capsulorhexis creation, this resident surgeon loses control of the anterior capsule edge and it runs all the way out…
the hemi-nucleus tuck technique
One of the challenges in phaco surgery is that we need to break up the nucleus in order to remove…
Removing OVD from behind the IOL
Surgeons in training often ask, “Do I need to remove the viscoelastic from behind the IOL at the end of…
Draining a choroidal hemorrhage
We recently featured a video of a sudden choroidal hemorrhage which happened during implantation of an IOL. This is a…
Review: Soft-Shell OVD technique
The Soft-Shell Technique for viscoelastic use in cataract surgery was developed by Dr. Steve Arshinoff as a method of getting the best…
Learn as I coach this resident
Many ophthalmologists from around the world have asked if we offer a fellowship, externship, or clinical rotation so that they…
Mastering Divide-and-Conquer
Most young ophthalmologists start learning phacoemulsification cataract surgery with the divide-and-conquer technique. This is an easier technique to learn than…
Cataract Quiz: What’s wrong with the IOL?
Time for a Cataract Quiz, featuring guest surgeon Dr. Sourabh D. Patwardhan from India, featuring a complication with an IOL.…
Pediatric Posterior Capsulorhexis
Our guest surgeon is Ike K. Ahmed MD from the Prism Eye Institute in the greater Toronto area. He is…
Dense Cataract Vertical Chop
For a dense cataract, the vertical chop technique works well because the chop will propagate through the nucleus. We have…
Spiral Capsulorhexis Technique
After needle decompression of the cataract, using a spiral technique for the capsulorhexis has a distinct advantage: if there is…
Review: if the bag shallows during cortex removal
The irrigation / aspiration probe is placed in the eye and we begin cortex removal. But as we try to…
How to: Challenging Uveitic Cataract
This patient has a long standing uveitis which is currently under control as well as uveitic glaucoma which required placement…
Submarine Chop for dense cataracts
For a dense cataract, performing phaco chop is challenging because the central lens nucleus is so hard that the chop…
White cataract needle decompression
We know that an intumescent white cataract is fluid-filled with liquefied lens cortex. This makes the pressure within the capsular…
Wrinkled and fibrotic lens capsule
This seemed like a typical white cataract during the pre-operative exam and when first placed under the surgical microscope on…
Complete Cataract Case: a very special case
This is a complete cataract case, shown from the making of the first incision to the sealing of the incision.…
Ruptured Globe: Key Teaching Points
Every ophthalmologist must know how to manage a ruptured globe. In this case it is a corneal laceration with a…
Review: Surgical Peripheral Iridotomy
here are times when you will need to make a surgical iridotomy either during cataract surgery or as a stand-alone…
Small incision glaucoma surgery
This video is amazing — when I first saw this technique, I was in awe because I learned so much.…
resident divide-and-conquer case 30
An anonymous resident sent in this video of his/her 30th cataract surgery which was done with the divide-and-conquer technique. The…
Cataract Quiz: Argentinian Flag Sign
Cataract Quiz: How can you prevent the dreaded Argentinian flag sign now? White cataracts can pose a challenge when performing…
Simplified pterygium technique
There is so much to learn about truly artistic pterygium surgery that we could likely make a PterygiumCoach.com website and…
Residual posterior polar opacities
We love to show posterior polar cataract videos and we have an entire category for them here on CataractCoach. Using…
Small pupil, PXF, and IFIS
For a beginning surgeon it is helpful to see surgeons performing techniques that are out of your comfort zone. The…
Review: Double Capsulorhexis for White Cataracts
Intumescent white cataracts pose a challenge because the lens cortex has degenerated so much that is has liquefied. This creates…
Pars plana anterior vitrectomy
The only ophthalmologists who have zero surgical complications are those who don’t operate and those who are not fully truthful.…
Expert level dense white cataract surgery
It is a pleasure to watch a true expert perform his craft and this is especially true for cataract surgery,…
Quiz: Why are there two main incisions?
Cataract Quiz: Why are there two phaco incisions in this eye? This is a routine cataract surgery and the case…
Fixing severe capsular phimosis
In a small number of patients, capsular phimosis can happen after cataract surgery. This can lead to severe distortion of…
Tough posterior capsule opacity
When a patient presents with a dense posterior sub-capsular cataract and there is difficulty removing all of the opacity, how…
Cataract Surgery in Silicone Oil Eyes
Retina surgeons will occasionally use silicone oil to help keep the retina in position during healing and in rare cases,…
Review: fixing beginner mistakes
Learning intra-ocular surgery is not easy and it can take years just to be comfortable with just the basics. Look…
The Subtleties of Cataract Surgery
The difference between good cataract surgery and great cataract surgery comes down to subtleties. There are very slight nuances to…
Bilateral brunescent cataract surgery
This patient has been functionally blind for 10 years and presents to us with bilateral, dense, brunescent cataracts. We must…
Quiz: What is different about this cataract?
Look carefully at the picture above and you will see something that is different about this white cataract. It is…
Resident Cataract Surgery Final Exam
Today is June 30 and that is the final day of residency training in the USA since our academic year…
Analysis of Resident Surgery Steps
This video features side-by-side double camera angles so that we can simultaneously see the microscope view as well as the…
Fluidic Analysis during Phaco Chop
It can be helpful to see the machine fluidic parameters in real-time as the phaco chop procedure is performed. We…
Review: capsule attachments with femto-laser
This young patient (about 40 years old), developed a white cataract which has severely impaired vision in this eye for…
Paired Incisions to fix Astigmatism
This is an easy technique that can be so helpful to all cataract surgeons. By using paired phaco incisions, we…
Pearls for small pupil cataract surgery
There are some great surgical pearls for dealing with small pupils during cataract surgery and this video explains some of…
Cataract Quiz: Why shift the capsulorhexis?
Looking at the picture above it seems like the capsulorhexis has been shifted nasally: it is much closer to the…
Complete Case: Cortical Cataract
With a cortical cataract, patients are very symptomatic, particularly if the cortical opacities are within the visual axis. These tend…
Resident Case Double Camera Angles
For experienced surgeons (which I define as those who have done at least a few thousand cataract surgeries), the microscope…
Complete Case: a very special patient
As a surgeon, it is always an honor when a colleague trusts you to operate on his eyes or on…
Review: Cataract surgery after prior RK
This patient was very myopic and desired surgical correction many years before the advent of the excimer laser. As such,…
Use Trypan Blue dye before OVD
Trypan Blue dye is very useful in cataract surgery because it can stain the anterior lens capsule which improves visualization…
Complete Case: loose zonular support
Another great video in our series of Complete Cataract Cases: a dense cataract in the setting of loose zonular support.…
Anterior Capsule Rips Uncontrollably
Quiz time: What do you do when the anterior capsule rips uncontrollably in a young patient who is scheduled to…
Complete Case: vertical phaco chop
Another complete cataract case, this time showing the vertical chop technique to split the cataract into two halves. This is…
Resident surgeon does case #100
For all of our young surgeons who are learning cataract surgery, this is a great video because it shows you…
resident toric IOL case double camera angles
Using double camera angles can help newer surgeons learn the nuances of surgery. This video shows a resident surgeon who…
Review: Optimizing Cycle Time Efficiency
Establishing a consistent routine in the operating room is the key for both increased efficiency as well as increased safety.…
Should you do surgery for this patient?
This is a complex patient who has many systemic medical issues and because her lab tests from this morning showed…
Complete Case: Efficient Phaco Chop
Another great video in our series of Complete Cataract Cases. You’ll be able to learn from the very first incision…
Quiz: Should I have used a pupil ring?
This is a tough case and the pupil is smaller than I expected. Should I have used a pupil expansion…
2 approaches to Posterior Polar Cataracts
Studies have shown that 1 out of 3 posterior polar cataract surgeries result in a ruptured posterior capsule. Here’s the…
Pre-Chop with just 2 Choppers
Guest surgeon Dr Valentin Apostolov from Amsterdam shows us his technique for splitting a dense nucleus into small fragments before…
From routine case to disaster in 1 second
When I first saw this video, which was submitted by an anonymous surgeon, I was in disbelief. I simply could…
Review: The Angle of Approach for Incisions
The angle of approach of the keratome will determine the tunnel length of our phaco incision. If the angle is…
Tough cataract case for a resident
We are thankful for the many video submissions we receive from our readers, particularly from residents or registrars who are…
Lessons Learned with 3-piece IOLs
Most cataract surgeons now use single-piece acrylic IOLs for the majority of their cases, with three-piece IOLs reserved for unusual…
Cataract Quiz: IOL with capsule tear
Cataract Quiz time: you have removed the lens nucleus and the cortex and you see that the anterior capsular rim…
Enlarge the Capsulorhexis
A small capsulorhexis makes nucleus removal more difficult, especially when we have a dense cataract. When the entire lens hardens…
Complete Case: Floppy Iris & Loose Zonules
There is a benefit to watching a video of a complete cataract case, from start to finish. This is particularly…