I have done cataract surgery for well over 1000 patients with prior radial keratotomy and on a recent surgical line-up, I had 4 of these patients on the same morning. For most RK patients with 8-cut RK, we can place our phaco incisions in between these RK cuts without intersecting them. However, in patients with 18-cut RK or 24-cut RK, that is not possible. In these eyes, I prefer to use a scleral tunnel incision which can provide a wider margin of safety. This video shows the technique of making the incision, but also the changes required to perform the rest of the surgery. The angle of approach is different with the scleral tunnel and intra-ocular access is not as easy compared to the typical corneal phaco incisions. This is a complete cataract case shown at 2x speed so that the video is still just about 5 minutes. Efficient learning for our CataractCoach fans.