Capsulorhexis: Good vs Great

In this picture, the capsulorhexis on the left is good because it is centered, continuous, and an appropriate size, but … More

Artificial Intelligence in Ophthalmology

The future is here and John Ladas, MD, PhD gives us a brief lecture about the Rules of the Game … More

Review: Why is Phaco Chop not working?

This patient certainly needs cataract surgery because the dense nucleus has a large degree of central opacity and that has … More

Toric IOL Alignment Dilemma

In this picture, all of these lines are at the 120 degree meridian, so how do you choose where to … More

Leukocoria in a newborn baby

Leukocoria in a newborn baby is an urgent situation that needs immediate attention from an ophthalmologist. The cause of the … More

Cataract Quiz: Where should you make the incision?

Our phaco incisions will induce an astigmatic change in the cornea and we can use that to help achieve a … More

Complete Case: Cataract in a Small Eye

Looking at this picture, we can see that the corneal diameter is very small compared to the size of the … More

How to Evacuate this Hyphema

This patient was struck in the eye with a Champagne cork, which was traveling at a high velocity and hit … More

How to Rescue this Capsulorhexis

We have previously discussed the Little Maneuver which is a method of saving a run away capsulorhexis. In this case, … More

Review: Pseudo-Exfoliation Cataract Surgery

Pseudo-Exfoliation / Small Pupil / Weak Zonules / Shallow AC (watch video below) A sweet 80 year old patient comes … More

Danger: Clear Crescent Red Reflex

When you are mobilizing a dense nucleus and you briefly see a bright, clear, crescent-shaped red reflex, you can be … More

Manual SICS with nucleus bisection

SICS is small incision cataract surgery, and it refers to a method of manual expression of the nucleus through a … More

Cataract Quiz: What happened here?

Look carefully at this picture: what do you see? There is a three-piece IOL in the sulcus and there is … More

The Chopper Push Technique

Watch this video carefully and you will see that the chopper instrument is used just once to create a single … More

Complete Case: Chop in the Bag

Again we have a complete case, from start to finish, showing a routine cataract surgery with a phaco chop technique. … More

You must learn this before finishing residency

The challenge of residency training is that you have just a limited time to learn surgery. You can read books … More

Review: Phaco Incision OCT Analysis

The phaco incision is part of your signature which links you to the patient’s eye forever. Your incision will forever be visible … More

Mentally Recovering from Complications

There are only two types of ophthalmologists who never, ever get surgical complications: (1) those who don’t operate, and (2) … More

Complete Case: Flomax & Toric IOL

Many of our CataractCoach.com readers have been asking for complete cases, shown from start to finish. There is a lot … More

Cataract Quiz: What is hidden in this pic?

Look carefully! There is something that needs to be addressed in this picture — it is not easy to see, … More

Cataract Surgery with Pterygium Present

For a patient with both a pterygium and a visually significant cataract, the best option is usually to do the … More

What are these lines? What is Reflux?

These lines are the posterior capsule which has found its way into the suction port of the I/A probe. We … More

Review: Optimizing Cycle Time Efficiency

Establishing a consistent routine in the operating room is the key for both increased efficiency as well as increased safety. … More

Posterior Polar without delineation

Posterior polar cataracts are unusual, but certainly every ophthalmologist will see these patients in their own clinics. While most surgeons … More

Posterior Capsule Rupture! Now what?

In this anonymously submitted case from a resident surgeon in training, there are many great lessons to be learned. We … More

How much force for hydro-dissection?

When we perform hydro-dissection, how much force is needed? What volume of balanced salt solution is required? What are the … More

Refining your Surgical Signature

It is so important for surgeons to take pride in their work. You must do a great job, or don’t … More

Setting Up for Cataract Surgery

Cataract surgery is team work and the surgeon is just one member of the team. We need a great team … More

Review: Posterior Capsulorhexis Technique

If there is a central posterior capsule plaque that cannot be removed with the suction from the irrigation/aspiration probe, we … More

Epi-Nucleus Flip Technique

With a thick epi-nuclear shell, it is easier to remove it with the phaco probe as compared to the I/A … More

Fix this Iris Prolapse in 2 seconds

Really. This is not an exaggeration. If you understand the physics of why the iris is prolapsing through the incision, … More

Cataract Quiz: The chop failed. Now what?

Even for expert cataract surgeons, sometimes the attempt at phaco chop fails. This can be due to many reasons and … More

Resident Cataract Case #165 Evaluation

This video is submitted anonymously by a resident ophthalmologist who has completed 164 cataract surgeries so far. This case, his … More

Trap a dense nucleus in order to chop it

With a very dense and fibrous cataract, using just the vacuum from the phaco tip to hold the nucleus is … More

Cortical Cataracts can cause “white-out”

Cortical cataracts occur when some of the lens material becomes liquefied, thereby blocking the visual axis. When we perform hydro-dissection … More

Review: External View of Cataract Surgery Steps

Two of the most critical steps in cataract surgery are the main phaco incision and the capsulorhexis. Properly completing these … More

Phaco Chop in patients over age 90

In previous videos we have explained the differences when operating on nonagenarian patients. These patients have weaker tissues such as … More

Toric IOL planning in a small eye (+29.5 D)

Our main phaco incision will induce astigmatism and multiple variables affect the degree of this change. Larger incisions have more … More

Complete Case: Brunescent & White Cataract

This patient truly needs our help. She developed a cataract in the right eye a few years ago and was … More

The surgeon will struggle to finish. Why?

In this resident surgeon case, the anterior chamber flattens and there is loss of viscoelastic upon attempted manipulation of the … More

The Smallest Permissible Capsulorhexis

From watching our videos, you know that for most cases, I find that a 5 mm capsulorhexis is ideal. This … More

Review: Side View of Hand Position

While we do hold the phaco probe with a pencil grip, we do not use the same angle as writing with … More

Trouble learning phaco chop? Try this first

One of the main reasons why phaco chop is more difficult to learn than divide-and-conquer is that there is a … More

The patient has a surprise for you…

You have scheduled a patient for cataract surgery and the case seems relatively routine. The biometry was good and the … More

Peeling off a Pupillary Membrane

In this complex case, there is a nearly complete pupillary membrane in an eye with a cataract and a prior … More

Complete Case: Dense PSC & Shallow AC

This is a complete case, shown from start to finish. For many of our CataractCoach viewers, particularly the surgeons with … More

Checking the IOP at the end of surgery

We want to ensure an appropriate intra-ocular pressure (IOP) at the end of surgery. This puts the eye in a … More

Review: IOL calcs in high hyperopia

Here is your challenge. You’re operating on a patient who is highly hyperopic (wearing +6.50 OD and +7.00 OS for … More

Two-Handed Capsulorhexis Technique

Our guest surgeon is Ravi Goel MD from New Jersey, USA who is also the author of the ProtectingSight.com blog. … More

Struggling with Phaco Chop? Let me help you

I will be the first to tell you that mastering phaco chop is not easy, but it is certainly worth … More

The trick to bring cataract pieces to the phaco tip

This is one of my favorite tricks to teach residents: when there is a nuclear piece of cataract in the … More

Review: Cataract Surgery in Pseudo-Exfoliation

We often encounter patients with Pseudo-Exfoliation Syndrome, often abbreviated as PXF, which makes cataract surgery significantly more challenging. The PXF … More

Cataract Surgery with Synechaie Lysis

Synechiae are adhesions of the iris to ocular structures which can cause issues of aqueous blockage, pupil dilation, and more. … More

Quick Fix for Reverse Pupillary Block

In myopic eyes and post-vitrectomy eyes, we can get an overly deep anterior chamber during cataract surgery. The infusion pressure … More

Cataract Quiz: Why did we get bleeding here?

In this resident case, the IOL is in the capsular bag, the capsulorhexis is intact, the viscoelastic has been removed … More

Phaco Incision Do-Over

In this case, the resident begins by making a phaco incision that is not good. The roof is too thin … More

Recovering from a radialized capsulorhexis

Learning to perform a consistent capsulorhexis is one of the toughest steps of cataract surgery. The anterior capsule is only … More

Simplified Technique for LRIs

Limbal relaxing incisions (LRIs) are a great option to treat pre-existing corneal astigmatism at the time of cataract surgery. They … More

List of Key Videos for Residents

A young doctor in training asked me to put together a list of key videos prior to her first day … More

What can we learn from the first eye cataract surgery?

The patient had cataract surgery of the right eye two years ago. Initially, she had a plano outcome and great … More

How far do you insert the Chopper for Phaco Chop?

A young surgeon who is new to phaco chop asked me how deep to insert the chopper tip into the … More

Resident Surgeon Learning to do Phaco Chop

In your quest to learn phaco chop, it is helpful to watch other beginning surgeons perform the same technique. In … More

Can we use a Toric IOL in Keratoconus?

Toric IOLs have the ability to neutralize corneal astigmatism at the time of cataract surgery to improve vision for our … More

Spiral Out Capsulorhexis for Intumescent Cataracts

Some white cataracts are intumescent which means that the capsular bag is filled with liquefied lens cortex. This fluid increases … More

Review: Surgical Peripheral Iridotomy

There are times when you will need to make a surgical iridotomy either during cataract surgery or as a stand-alone … More

Traumatic Cataract with Mydriasis: Part 2 Pupilloplasty

This patient suffered severe trauma as the result of an airbag injury from a car accident about one year ago. … More

Traumatic Cataract with Mydriasis: Part 1 cataract surgery

This patient suffered severe trauma as the result of an airbag injury from a car accident about one year ago. … More

Cataract Quiz: What is this white plume?

The phaco probe is placed in the eye at the beginning of the cataract surgery and when ultrasonic energy was … More

Severe Capsular Phimosis

Capsular phimosis occurs when there is severe contraction of the anterior capsular tissue which results in a shrinking of the … More

Artificial Iris Implants

Kevin M. Miller MD is a world-renowned cataract surgeon at UCLA’s Jules Stein Eye Institute and he was an instrumental … More

Choosing Toric IOL Steps

For toric IOLs, we need to select the best spherical power as well as the ideal toric step. What is … More

Review: 12 Consecutive Capsulorhexes

Seeing the same step of surgery performed over and over again can help beginning surgeons learn the subtleties of the … More

Re-draping the eye makes surgery more efficient

When we place the drapes on the eye and eyelids, it serves to give us better exposure of the surgical … More

Highly Efficient Stop-and-Chop

From watching videos here on CataractCoach.com, you’re aware that my favorite method of nucleus division is phaco chop. Any form … More

Quiz: What will happen next? Look carefully

This picture tells me that there is going to be an issue during this case. As soon as the incision … More

It takes new surgeons years to figure this out

This is such a great lesson, that I’m going to limit the text here. Watch the video and learn something … More

Tear Out of the Anterior Capsule

In this video, which was anonymously submitted, an experienced surgeon encounters a routine cataract case where the anterior capsule is … More

White Cataract with Fibrotic Lens Capsule

This video was submitted by an anonymous surgeon who is attempting this case early in the course of surgical training. … More

Review: YAG laser capsulotomy techniques

Posterior capsule opacification (PCO) is common after cataract surgery. Even a perfect surgery by a master surgeon still leads to … More

Always check under the Iris

We have covered this lesson before, but it certainly is worth repeating: always check under the iris when you perform … More

Cataract Surgery Lessons from Kyoto

I recently went to Kyoto, Japan for ophthalmology business development projects and I also had a chance to visit a … More

Flip and Chop in post-PPV eyes

With a prior pars plana vitrectomy, the anterior hyaloid face is gone and therefore there is less support for the … More

Post-LASIK IOL Power Estimation

In eyes with prior LASIK, many different methods of IOL power estimation have been described to get more accurate results … More

Review: External View of Phaco Chop

Most of the videos on this site are taken through the operating microscope. This gives the view of exactly what … More

Do not vacuum near the corneal endothelium

During cataract surgery, you notice a small lens fragment or an air bubble float up to the corneal endothelium, where … More

The chop failed, so I reverted back to this…

The benefit of learning many different phaco techniques is that you can choose the one that is best for each … More

Quiz: Cataract & Penetrating Corneal Injury

This patient had a penetrating corneal injury many years ago. When we look at the eye we can see evidence … More

Learning Vertical Chop

Vertical chop means that both the phaco probe and the chopper are placed within the capsulorhexis and then both are … More

Full List of All Videos by Category

Here is a complete list of all videos sorted by category. This list will be continuously updated as we post … More

Slow Motion Phaco Chop

In the course of giving lectures across the USA and around the world, I meet many experienced ophthalmologists who find … More

Methods of Capsule Polishing

For polishing of the undersurface of the anterior capsular rim, we can use a friction method with specialized instruments or … More

Review: 1 or 2 hands for the capsulorhexis?

The capsulorhexis is one of the most important and most challenging steps of cataract surgery. When you are performing the … More

Guest Surgeon Phaco Chop Technique

One of the hallmarks of a good surgeon is the ability to learn from other surgeons. In this case we … More

Making a Scleral Tunnel Phaco Incision

For 99% of my patients, making a corneo-limbal phaco incision is ideal. However, there are cases such as this patient … More

Quiz: What does this sign mean?

You are just about to start the capsulorhexis and you notice that the anterior lens capsule has straie emanating radially … More

Opacities seen during cataract surgery

In this unusual case we see opacities in the red reflex during cataract surgery. Most of these are within the … More

Draping the Eye for Cataract Surgery

Draping the eye is important for cataract surgery. It helps us to create a sterile field and it isolates the … More

Review: Check under the iris for lens material

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

Capsulorhexis with an anterior capsular plaque

This anterior capsular plaque makes the capsulorhexis creation more challenging. The capsule will not tear predictably in the region of … More

Mastering Divide-and-Conquer Phaco

Back by popular demand! Most beginning surgeons start by learning divide-and-conquer as the primary method of nucleus division for cataract … More

Quiz: Why is this phaco chop going to fail?

Look at this photo carefully. We can tell that this phaco chop will fail and the nucleus will not be … More

Cataract Surgery in a 100-year-old patient

We should all be so lucky to live to 100 years old. It’s quite a rarity and it is something … More

Cataract Surgery after Corneal Transplant

Cataract surgery in an eye with a prior corneal transplant is more difficult and there are challenges which can alter … More

Cataract Surgery & Lattice Corneal Dystrophy

Today we have a guest surgeon, Dr Carlos Yuji Nunomura from Brazil, who is demonstrating cataract surgery in an eye … More

Lysis of Synechiae and Cataract Surgery

In patients with prior uveitis, synechiae between the iris and the anterior lens capsule can develop. These adhesions will prevent … More

Phaco Chop in the bag with smaller pupils

In many of the prior videos related to smaller pupils, I have emphasized the technique of bringing the nucleus partially … More

Guest Surgeon “Submarine Chop”

We all learn from each other and today’s video is a great example of that. We are learning from Dr. … More

Easy way to fix iris prolapse

We have all experienced it: the case is going well but then the iris starts to prolapse out of the … More

Working near the corneal endothelium

We have to be very careful to protect the corneal endothelial cells, particularly in the center of the patient’s visual … More

Review: Achieving the State of “Flow”

The psychological state of Flow is described as “energized focus, full involvement, and enjoyment” of the action being performed. Some call this … More

Do you really want to learn surgery?

This is one of the most important videos that I have ever made. If you only watch one of my … More

I am thankful for…

Today is Thanksgiving in the USA, which is a holiday in the USA when we give thanks to the people … More

Quiz: Why is the vision 20/200?

This patient has a pre-op visual acuity of just 20/200 but the cataract does not look that bad. Also, we … More

Evaluation of Tilt-and-Tumble Phaco

An anonymous surgeon has submitted a video of the tilt-and-tumble phaco technique which tends to work well with milder degrees … More

Cataract Surgery prior to Glaucoma Surgery

We know that this patient will be undergoing glaucoma surgery in the near future and you are doing the cataract … More

Left-Handed Phaco: What is different?

In this video we review the differences between right-handed phaco and left-handed phaco. As expected, the instruments are held differently, … More

Review: Choosing Phaco Machine Settings

Surgeons often ask about which phaco settings are best. The answer is that it depends on the surgeon, the machine, … More

I/A probe going under the cortex

Most of the time, we grab the cortex edge under the anterior capsular rim and then we strip centrally. But … More

Cataract Surgery in Keratoconus

When a patient has keratoconus, what is different about the cataract surgery? Can you still make your phaco incision in … More

Quiz: What is this focal lens opacity?

What is this focal lens opacity that is seen during cataract surgery? And how do we remove it? What likely … More

Challenges with a smaller capsulorhexis

What are the challenges with a somewhat smaller capsulorhexis? In most of my cataract cases, I try to make a … More

Three-Plane Phaco Incisions (Tri-Planar)

Making the phaco incision is one of the most critical steps in cataract surgery. A well-constructed incision will seal without … More

Watch out for the tubing lines!

This is a simple, but important, lesson: keep the tubing lines and the phaco power cord away from your surgical … More

Review: Learn Horizontal Phaco Chop

The original phaco chop technique described by Dr. Nagahara in 1995 was the horizontal chop. This involves holding the lens … More

Expert Level Divide-and-Conquer

Many surgeons like the divide-and-conquer technique and it is widely used here in the USA. For young surgeons, it is … More

Evaluation of a resident chop technique

This video was submitted by a resident in Asia who is still learning phaco and has upgraded to using the … More

Does Capsulorhexis direction matter?

Does it matter which way you perform the capsulorhexis? Clockwise or counterclockwise, which is better? What about for right handed … More

How to sculpt a nuclear groove

Sculpting a groove in the nucleus is required for techniques such as divide-and-conquer and stop-and-chop. The groove works best when … More

How to do Limbal Relaxing Incisions

Just about any incision in the cornea will induce some astigmatic change. We have shown how to place the phaco … More

Guest Surgeon: Phaco Chop Technique

This video was anonymously submitted by an experienced surgeon who wants us to analyze the phaco chop technique and give … More

Resident Stop and Chop Cataract #50

After doing 50 cataract surgeries, most beginning surgeons have developed good technique for the steps of the procedure. For surgeons … More

Quiz: what is different about this white cataract?

This patient has an intumescent white cataract but something is different about this case. In fact, there is a very … More

Cataract surgery in Nanophthalmos

Nanophthalmic eyes are very small with a short axial length of less than 20 mm. This makes the cataract surgery … More

Pre-Chopper Phaco Technique

There are many different ways to divide the nucleus during cataract surgery. Phaco of smaller nuclear fragments is easier and … More

CTR Technique with less capsular stress

We have featured prior videos about insertion of capsular tension rings (CTRs) during cataract surgery. These devices can be very … More