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 … More

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 … More

Pseudo-Exfoliation White Cataract

Our guest surgeon today is a young ophthalmologist from Spain and he is performing phaco for a patient with a … More

Four handed phaco! What?

This is a case where we knew ahead of time there would be issues. The patient is mid 50s in … More

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 … More

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 … More

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. … More

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 … More

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 … More

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 … More

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 … More

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 … More

Cataract Quiz: Zonular Dehiscence

Our guest surgeon is Dr Willie Kan from Malaysia and he presents a very tough case: a traumatic white cataract … More

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 … More

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 … More

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 … More

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 … More

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 … More

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 … More

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 … More

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 … More

Playlist: Capsulorhexis

The capsulorhexis is an important step of cataract surgery. It allows us to maintain the strength of the capsular bag … More

anterior segment total reconstruction

This is a very complex case of a patient who had cataract surgery elsewhere and sustained complications during the procedure. … More

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 … More

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 … More

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 … More

Punctured Posterior Capsule Rescue

There are two types of ophthalmologists who do not ever have surgical complications: those who do not operate and those … More

Ruptured Posterior Capsule Recovery

This patient had uneventful cataract surgery in the first eye with placement of a toric trifocal IOL in the capsular … More

Playlist: Traumatic Cataract

The eye is a delicate organ and trauma can cause many challenges during cataract surgery. The more common issues include … More

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 … More

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 … More

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. … More

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 … More

Playlist: Iris Prolapse

Iris prolapse is a relatively common issue in cataract surgery and its management is critical to the success of the … More

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 … More

Femtosecond Laser White Cataract

Our guest surgeon today is Xiongfei Liu MD from Sacramento, California. He was previously a resident with us at our … More

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 … More

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 … More

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 … More

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 … More

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 … More

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 … More

Combined Phaco + DMEK Surgery

Descemet Membrane Endothelial Keratoplasty (DMEK) has become the preferred surgical technique for the treatment of Fuchs’ corneal dystrophy. In the … More

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 … More

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 … More

Playlist: Complete Cataract Cases

There is so much to be learned by watching a complete surgery, from start to finish. These complete cataract cases … More

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. … More

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 … More

MSICS in Pseudo-Exfoliation

It is important to learn how to perform MSICS: manual small incision cataract surgery. This is a more evolved and … More

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 … More

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 … More

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 … More

White Cataract Double Capsulorhexis

It is always a pleasure to learn from a master surgeon like Dr Pradip Mohanta from West Bengal, India. He … More

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 … More

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 … More

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 … More

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. … More

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 … More

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, … More

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 … More

Soft versus Dense Cataracts

Our guest surgeon, Dra. Luz Marina Melo from Colombia, shows us two very different techniques for soft versus dense cataracts. … More

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 … More

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 … More

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 … More

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 … More

adherent posterior capsule plaques

You are doing cataract surgery for a patient with a dense nucleus, an advanced cataract, with barely count fingers vision. … More

warning: phaco wound burn!

This is among the most important cataract surgery videos that you will see in your lifetime. Really. I have taught … More

the bowled out nucleus

We have all experienced it: a nucleus that it too soft and gummy to divide in the capsular bag and … More

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 … More

Cataract Quiz: intumescent decompression

One of our favorite topics on CataractCoach is the intumescent white cataract. We know that the capsular bag is pressurized … More

Amazing Pterygium Peeling Technique

After more than 20 years of doing ocular surgery, there are only a few surgical pearls that amaze and surprise … More

Small Capsulorhexis Phaco Chop

The capsulorhexis is an important part of cataract surgery and one reason is that it allows access to the inside … More

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 … More

Incisional Techniques for Astigmatism

Cataract surgery can be our most powerful refractive surgery procedure, correcting high degrees of myopia, hyperopia, and even astigmatism (with … More

Review: Uveitis, Glaucoma, Cataract

Cataract surgery in an eye with uveitic glaucoma Stepwise approach to surgical success Cataract surgery in eyes with small pupils … More

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 … More

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 … More

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 … More

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 … More

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 … More

choosing refractive targets

Plano is not always the goal It would seem logical that emmetropia is the ideal refractive state of the eye. … More

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 … More

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 … More

Rotary Chop Technique

The key to splitting a brunescent cataract is to access the central endo-nucleus. This is the densest part of the … More

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. … More

Phaco Chop without Vacuum

It is a pleasure to watch an expert surgeon doing cataract surgery and I really enjoyed learning from Dr. Alex … More

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 … More

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 … More

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 … More

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 … More

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 … More

Drill and Chop Technique

With a dense cataract, more effort and force is needed to chop the cataract. Usually with phaco chop, it is … More

Surprise! Loose Zonular Support!

This patient has a dense cataract and a surprise waiting for the surgeon: as the nucleus is being cracked, we … More

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 … More

Corneal Phaco Incision Hydration

The technique of corneal stromal hydration to help seal a phaco incision is useful to ensure a watertight incision and … More

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 … More

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 … More

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 … More

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 … More

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 … More

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 … More

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 … More

scleral tunnel phaco incisions

Many years ago, incisions for cataract surgery were made in the sclera, even for the small phaco incisions. The scleral … More

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 … More

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 … More

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 … More

compilation video: dense cataracts

This compilation video features the best of many prior videos regarding dense cataract techniques. The video has many clips which … More

Challenge: Monocular Dense Cataract

Operating on a monocular patient is always stressful since we know that the stakes are higher due to the patient … More

Equanimity under Duress

When Sir William Osler left the University of Pennsylvania’s Medical School (the first one in the USA, started in 1765) … More

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 … More

Glaucoma Drainage Implant Technique

I have learned so much from the video submissions that we receive at CataractCoach. It makes me wonder how I … More

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) … More

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 … More

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 … More

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. … More

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 … More

Intumescent Cataract Auto Aspiration

We know that intumescent white cataracts can be challenging because the lens capsule is pressurized with liquefied lens cortex. This … More

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 … More

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 … More

Lateral Phaco Chop Technqiue

With traditional phaco chop, we place the chopper in front of the phaco probe tip, but there are other options. … More

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 … More

Capsulorhexis Pearls

By watching many surgeons, we can learn different ways of performing the same procedure. In this case, Dr Luis Escaf … More

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 … More

Peeling Capsular Membranes

We present another great learning video from Dr. Val Apostolov from Amsterdam, The Netherlands to show the techniques of peeling … More

Bare Sclera Pterygium Surgery

There are many ways to do the same surgery and the best option is for us to learn about all … More

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 … More

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 … More

Fibrotic Dense White Cataract

This patient developed a white cataract years ago and was unable to seek treatment for a prolonged period of time. … More

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 … More

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 … More

Uveitic Dense White Cataract

This dense white cataract is further complicated by being an a uveitic eye with a fibrotic membrane causing a small … More

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 … More