Expert Technique: Small Pupil & Dense Cataract

Very experienced surgeons never rest — they are always looking to learn more. Like you, I learn a lot from watching videos of other surgeons operating. Recently, I have enjoyed learning from Lukan Mishev MD from the Focus Eye Center in Sofia, Bulgaria. Dr Mishev is well-known for live streaming thousands of ocular surgeries on his YouTube channel where he does cataract surgery, glaucoma procedures, and even vitreo-retinal surgeries.

I enjoyed this video where he does a beautiful cataract surgery in a patient with a dense cataract and a small pupil. His high degree of skill means that he does not need a pupil expansion ring or even Trypan blue dye. In addition, his high-tech video set-up allows for picture-in-picture showing his phaco machine parameters live with the surgery.

If you’re a novice surgeon, keep in mind that this video is of an expert surgeon with advanced skills. If you’re doing a similar case, I recommend pupil expansion as well as Trypan blue dye.

If you’re already a very experienced ocular surgeon, there are some very important learning points here: the way that the capsulorhexis is made larger than the pupil size with just a few grabs, the placement of the chopper around the nucleus equator without direct visualization, and then the ability to bring nuclear pieces through the small pupil without inducing further miosis.

Click below to learn from Dr Mishev performing this challenging case:

Leave a Reply