A young doctor in training asked me to put together a list of key videos prior to her first day…
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…
Bad Incisions lead to trouble
This anonymous resident starts the case with a poorly placed and poorly constructed incision. It ends up bleeding, allowing blood…
White Cataract Double Capsulorhexis
It is always a pleasure to learn from a master surgeon like Dr Pradip Mohanta from West Bengal, India. He…
Cataract Quiz: Where is the hidden piece?
Time for another cataract quiz — look carefully at the photo above. Where is the nuclear fragment hiding? And how…
Cataract Quiz: When did the break happen?
This patient has a relatively dense cataract and requires a toric IOL for 2 diopters of regular corneal astigmatism. When…
Cataract Surgery for a Cataract Surgeon
cataract surgeon for a cataract surgeon
Crucial lessons learned in residency
A complication during surgery can be a mistake or it can be a lesson. The difference between them is that…
Playlist: Stop-and-Chop Technique
If you are currently performing the Divide-and-Conquer technique of nuclear division, then moving to the Stop-and-Chop technique is relatively easy.…
Capsular tension rings in PXF
capsular tension rings (CTR) in pseudo-exfoliation (PXF) cataract surgery
Future of IOL calculations: AI
In just 5 minutes this video will show you the future of IOL calculations. Imagine if you met someone who…
Finishing this case will be difficult
The reason why ophthalmologists need to perform at least 1,000 cataract surgeries until they are sufficiently up the learning curve,…
Cataract Quiz: how to rescue this case
This patient has an intumescent white cataract and we know that poses a risk of capsular run-out due to the…
Soft versus Dense Cataracts
Our guest surgeon, Dra. Luz Marina Melo from Colombia, shows us two very different techniques for soft versus dense cataracts.…
Pars Plana Injection of BSS
Our guest surgeon, Dr Mohammad Abusamak from Jordan, is performing cataract surgery on this monocular patient who has a high…
Playlist: Cataract Surgery in Myopia
playlist: cataract surgery in myopia
Cataract Quiz: What should you do?
What are these dark spots seen in the red reflex as you are about to start cataract surgery? What do…
tiny pupil and fibrotic membrane
This is a very tough case for this senior resident. The patient has a history of chronic uveitis, which has…
complete case: phaco chop in myope
Complete Cataract Cases are videos where we show the entire surgery, from the first incision (usually the paracentesis in my…
adherent posterior capsule plaques
You are doing cataract surgery for a patient with a dense nucleus, an advanced cataract, with barely count fingers vision.…
warning: phaco wound burn!
This is among the most important cataract surgery videos that you will see in your lifetime. Really. I have taught…
the bowled out nucleus
We have all experienced it: a nucleus that it too soft and gummy to divide in the capsular bag and…
Playlist: a new feature for learning
a new feature: Playlists to give suggested videos for review
Learning Phaco Chop: you can do it!
Young surgeons need to learn to perform phaco chop — it makes cataract surgery efficient and increases safety. Less ultrasonic…
Cataract Quiz: intumescent decompression
One of our favorite topics on CataractCoach is the intumescent white cataract. We know that the capsular bag is pressurized…
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…