Flip and Chop for Highly Efficient Cataract Surgery

Phaco flip is an efficient procedure since the initial hydro-dissection brings the nucleus out of the capsular bag. If we … More

Persistence during Phaco Chop is critical

It is critical that you not give up on phaco chop as a technique but also within a surgical procedure. … More

Poor Draping leads to more Complications

This case should be a routine, straightforward surgery with a low chance of complications. But that changes when the draping … More

Vertical Chop Technique for Efficient Surgery

The vertical chop technique is a favorite of mine, particularly when there is sufficient nuclear density to allow the chop … More

Please do NOT use the iris to guide Capulorhexis size!

Many surgeons use the iris or pupil size as a guide for capsulorhexis creation — but you should not. Do … More

Switching from Vertical Chop to Horizontal Chop

Sometimes cataract surgery is like playing basketball or soccer: you know many different techniques and special moves, but the key … More

Small Pupil Flomax Adventures (without a ring!)

This is a really fun cataract surgery. After tens of thousands of cases, an unusual or challenging clinical situation really makes … More

Use the Chopper for Hemi-Nucleus Management

The chopper can do so much more than chop. It can be used to fixate the eye via the paracentesis, … More

Shifting the Phaco Incision to treat Astigmatism

Our phaco incisions always have some degree of astigmatic effect by causing relaxation of the corneal curvature at that axis. … More

Four Quadrant Chop & Conquer Technique

Many ophthalmologists in training start out by learning the four quadrant divide-and-conquer technique, which has a long history of being … More

Pupil Stretch using Capsulorhexis Forceps

To stretch a small pupil, you actually don’t need special instruments. Using two instruments such as choppers, hooks, or manipulators, … More

Why did this Phaco Chop fail to split the cataract?

In order to do a successful phaco chop, we need to make sure that the high vacuum level of the … More

Why you MUST learn Phaco-Chop (Resident Case)

A critical part of being an accomplished ophthalmologist is keeping up with the advances in your field. For cataract surgery, … More

Avoiding Iris Prolapse when Sealing the Incision

When doing cataract surgery in patients with floppy iris syndrome, the iris has a tendency to prolapse via the phaco … More

Tips & Tricks for Using Pupil Expansion Devices

While I don’t use them often, pupil expansion devices such as the Malyugin ring, are useful when performing cataract surgery … More

Pupil Size in Pseudo-Exfoliation Cataract Surgery

Pseudo-exfoliation (PXF) syndrome can make cataract surgery more challenging because of the concomitant issues that exist in these eyes. The … More

Treating Iris Bleeding during Cataract Surgery

Typically, modern day phacoemsulification cataract surgery is relatively bloodless because we are making incisions in the cornea and then operating … More

Cataract Surgery after Pars Plana Vitrectomy

Three key points to consider when you perform cataract surgery in an eye with prior pars plana vitrectomy: Check the … More

Hidden Nuclear Fragment during Cataract Surgery

When we break up the cataract during phaco surgery, we create many small little pieces which are then aspirated from … More

Check under the Iris for Hidden Cortex Material

When performing cataract surgery for an eye with a moderate or small pupil, be sure to check under the iris … More

Hydration & Sealing of Corneal Phaco Incisions

A properly constructed phaco incision will allow good access to the anterior chamber for cataract surgery and then will seal … More

Ocular Albinism Cataract Surgery

Ocular albinism poses a number of challenges for cataract surgery. The patient often has concomitant nystagmus, underlying amblyopia, macular issues, … More

Cataract Surgery in Retinitis Pigmentosa

While retinitis pigmentosa is considered a rare disease, it occurs with enough frequency that every cataract surgeon will encounter it … More

Fixing a Radialized Capsulorhexis in manual ECCE

When I first started teaching residents about 20 years ago, we would have the residents do about 10 surgeries of … More

Cracking the Posterior Plate in a Dense Cataract

With a dense brunescent cataract, one of the primary challenges is cracking the fibrous posterior plate of the nucleus. Using … More

Dealing with Conjunctival Chemosis

We have covered the topic of the rules for an ideal phaco incision and one of them is to barely … More

Bimanual Irrigation / Aspiration for Cortex

For most cases a coaxial arrangement of both the phaco and irrigation / aspiration (I/A) handpieces works very well. However, … More

Floppy Iris Syndrome with Phaco Chop

We have a fun case here: the patient has a long-time history of Flomax (tamsulosin) use which limits his pupil … More

What if the Capsulorhexis is too big?

Ideally, the capsulorhexis diameter should be slightly smaller than the optic diameter so that we can achieve 360° overlap. But … More

For the Capsulorhexis: Femto or Forceps?

Was the capsulorhexis show in this photo done with a femtosecond laser, a micro-pulse electrical zap, or simply with capsule … More

Surgical Exposure is Critical in Cataract Surgery

Head positioning and exposure of the surgical field is important for success in phacoemulsification. The patient should be supine with … More

One-Chop Technique for Phaco Surgery

For a cataract with moderate nuclear density, splitting the nucleus into two halves can be sufficient for removal with phacoemulsification. … More

Soft Posterior Polar Cataract Technique

This is a patient with a history of high hyperopia (+7.5 of hyperopia) and posterior polar cataracts since childhood. The … More

Flatten the Anterior Lens Capsule with Viscoelastic

Using a Viscoelastic (also called Ophthalmic Visco-surgical Device, or OVD) to flatten the anterior lens capsule is a critical step … More

Novice Surgeon attempts a Dense Brunescent Cataract

Today we feature a brave and talented young surgeon who has only about 30 cataracts of experience so far. And … More

Managing Mild Iris Prolapse during Phaco

The iris can prolapse any time that a pressure gradient exists in front of, and behind the iris tissue. This … More

Management of the Hemi-Nucleus in Cataract Surgery

Whether you do phaco chop or stop-and-chop, you will be left with two halves of the nucleus which then need … More

Lifting the nucleus up though a small pupil

Here at CataractCoach, we have featured videos showing how to hydro-dissect a nucleus up, out of the capsular bag and … More

Expansion Ring for Small Pupil Cataract Surgery

For small pupil cases, I prefer to do stretching in order to expand the pupil and then I can proceed … More

IOL Calculations in Ultra High Myopia

Most people consider high myopia to be about -10 diopters or greater. We have covered this topic extensively in the … More

Beginning Surgeon Stop-and-Chop Case

We did a survey recently and about 20% of our viewers indicated that they wanted more videos of novice surgeons … More

Cataract Surgery with Traumatic Zonular Loss

Are you ready for a challenge? This patient is a relatively young construction worker who sustained a blunt traumatic ocular … More

Adapting your Phaco Chop Technique to each Eye

I encourage ophthalmologists in training to learn multiple different nucleo-fractis techniques so that they can tailor the cataract surgery to … More

Hydro-delineate if the Capsulorhexis is too small

Hydro-delineation is a valuable tool particularly in cases where the capsulorhexis is small because it allows us to separate the … More

Hydro-Dissection versus Hydro-Delineation

Once the capsulorhexis has been created, it is helpful to use balanced salt solution to loosen and separate the cataract … More

Hands or Machines: What is more important?

There is an old saying, “a good workman never blames his tools,” and that holds true for ophthalmic surgery as … More