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

Review: Angle sweep to remove all OVD

When we fill the eye with viscoelastic, we push it with the greatest force into the opposite angle of the … More

Cataract Surgery Draping is Critical

Watching amazing intra-ocular acrobatics during a challenging cataract case is exciting and makes for a great video, but those cases … More

Close Up: Technique for Phaco Incision

We have shown many videos about the importance of the phaco incision. It is part of the signature that you … More

Quiz: iris is prolapse & bleeding – now what?

Quiz time: This patient has floppy iris syndrome from tamsulosin use and you are experiencing iris prolapse during his cataract … More

Capsulorhexis technique with just forceps

In more than 99% of my cataract surgery cases, I do not use a cystotome to start the capsulorhexis. I … More

Surgeon Ergonomics for Ocular Surgery

As an ophthalmic surgeon, you will spend a large part of your future in the operating room performing delicate ocular … More

When should we leave “good enough” alone?

When should we leave “good enough” alone? Ophthalmologists tend to be perfectionists in nature and I certainly fit that description. … More

Review: An easy way to help seal the incision

If your phaco incision is properly constructed, it will typically seal quite well without the use of sutures. We can … More

Sit temporal but operate using WTR incisions

With-the-rule (WTR) astigmatism is where the steep axis is at or near the 90 degree axis. Placing incisions on the … More

Secrets to Avoid Corneal Edema after Cataract Surgery

Corneal edema can occur after cataract surgery due to a number of factors such as a higher degree of ultrasonic … More

Quiz: What are these spots seen during surgery?

During cataract surgery for this patient, everything seemed relatively routine. The patient is elderly with some zonular laxity, but even … More

Use the Chopper to Lift Nuclear Pieces Up

In cases where the capsulorhexis is small or where the nucleus is particularly large, it can be difficult to bring … More

Learn the Pupil Stretch Technique

Stretching the pupil during cataract surgery is a safe and effective way to improve access via mechanical dilation. While there … More

Analysis of a Divide-and-Conquer Cataract Case

This anonymously submitted video is from a surgeon who is 5 years into practice after the culmination of her training. … More

Review: Embed the phaco probe without ultrasound

The classic teaching for phaco chop and quadrant removal is to embed the phaco probe into the nuclear piece by … More

How to Save this Run-Out Capsulorhexis

This case is performed by a junior resident who has done about 20 cases so far. The trouble starts when … More

Lysis of Synechiae and Capsule Staining under Iris

This patient had a prior episode of anterior segment inflammation which caused synechiae to develop, with adhesion of the iris … More

Quiz: Why does this pupil look irregular?

This patient is undergoing a combined cataract surgery with a pars plana vitrectomy. Two novice surgeons are operating: a senior … More

Combined Phaco + MIGS for cataract + glaucoma

Cataract surgery alone is a powerful technique for lowering intra-ocular pressure, particularly in patients with glaucoma. By replacing the 4+ … More

Combined Phaco + DMEK Surgery for Fuchs’ Dystrophy

This patient has a cataract as well as Fuch’s corneal dystrophy. Her pre-operative corneal pachymetry is almost 700 microns centrally … More

What is the correct way to hold a fluid syringe?

When we have a syringe that is filled with liquid, be it balanced salt solution or visco-elastic, we have a … More

Review: Cataract Surgery in Deep Set Eyes

Performing intra-ocular surgery in a deep set eye is challenging because the access is limited. In the case shown here, … More

Paired Phaco Incisions to Treat Astigmatism

Cataract surgery is our most powerful refractive procedure based on the spherical power that we can correct. Anything from –30 … More

Does Capsule Polishing prevent capsular opacity?

There has been much debate around the issue of polishing of the undersurface of the anterior capsular rim, yet there … More

Resident Double Capsulorhexis for White Cataract

We know that intumescent white cataracts have a pressurized capsular bag with the milky white, liquefied cortex material. And we … More

Guest Surgeon Efficient Divide-and-Conquer

After thousands of cases, surgeons become very efficient and can complete cataract procedures with fewer instruments and less surgical trauma. … More

Two important danger signs in traumatic cataract

Guest surgeon and expert Ashraf Armia MD shows us two very important danger signs in a traumatic cataract case: wrinkles … More

Surgical Approach to a Traumatic Cataract

When we are faced with a traumatic cataract, there are many factors to consider. The easiest issue is the lens … More

Review: Phaco Incision OCT & Live Video 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

Why are we making a small capsulorhexis?

In many previous videos, we have explained why it is important to have a sufficiently large capsulorhexis. For an optic … More

Linear marks seen during cortex removal

For surgeons with just a few years of experience, the part of cataract surgery where a posterior capsule break is … More

Phaco Chop without using the phaco probe

This is a cataract surgery performed by a resident in training and the patient is known to have Fuchs’ corneal … More

Achieving a complete hemi-nuclear split

When performing any nucleo-fractis technique, it is imperative that the nucleus be completely subdivided prior to removing the halves, quadrants, … More

Review: Cataract Surgery in Patients age 90+

Average life expectancy is at an all-time high in the US at 79, with even better news for people who … More

Resident Surgeon takes on a Dense White Cataract

It is a pleasure to show you this video where one of my senior residents performs and excellent cataract surgery … More

Slow motion analysis of posterior capsule rupture

Watching surgical video of cases is very helpful to understand the how and when of the complications of cataract surgery. … More

Quiz: What is the huge danger seen in this photo?

This surgery is being performed by a senior resident and it starts off great. It is a dense white cataract … More

Novice surgeon performs cataract surgery

This video was anonymously submitted by an ophthalmology trainee outside of the USA. He has completed about 90 cataract surgeries … More

Analyzing a resident Stop-and-Chop case

Most of the uncut surgical videos that are shown here are very efficient and complete cases can be performed in … More

Toric IOL with intra-operative aberrometer use

Guest Expert John Hovanesian MD implanting a Toric IOL with aberrometer guidance Dr. Hovanesian is a well-known and much respected … More

Review: Temporal vs Superior Phaco Incisions

Some surgeons prefer to make a superior phaco incision while others prefer a temporal approach. Is there a substantial difference … More

Advice for young ophthalmologists for future success

Today we celebrate our 500th post with keen advice for young doctors. We did it. We have published a cataract … More

Milky fluid leaks out of the intumescent cataract

We have explained over the course of many videos that intumescent white cataracts are challenging. One of the primary considerations … More

Quiz: For a pupil like this, what is your approach?

With time, young ophthalmologists develop surgical judgment and they are able to look at a case and decide what approach … More

Cataract Surgery using a Scleral Tunnel Incision

Twenty years ago, when I did my residency training at the Jules Stein Eye Institute at the UCLA School of … More

Where did the hemi-nucleus go?

This video was submitted by Dr Ravi Prasad Challa from India and it showcases a very rare complication: a break … More

Pars Plana Anterior Vitrectomy can be very helpful

When the capsule breaks during cataract surgery and the vitreous prolapses into the anterior segment, it is important to clear … More

Review: Be Careful if you see the Hole Punch Sign

In your first 1000 cataract surgeries, the most common cause of a posterior capsule rupture is iatrogenic damage from the … More

How to rescue this capsulorhexis before it runs out

Performing the capsulorhexis is one of the most stressful steps for new ophthalmologists who are beginning to learn cataract surgery. … More

Quiz: How to fix iris prolapse at the incision

The iris is a kinetic and flowing structure that moves during pupil constriction and dilation. But the iris can also … More

Phaco Flip & Chop is great for Beverly Hills Cataracts

Often, the density of the nucleus and the severity of the cataract relates to the patient’s access to healthcare. In … More

Synechiae & Small Pupil solved with the B-Hex ring

This video features guest surgeon Neto Rosatelli MD from Brazil showing us his approach to cataract surgery in a uveitic … More

Solving a tough case of Hexagonal Keratotomy

Featuring guest surgeon: Arun Gulani MD from Jacksonville, Florida, USA This complex case involved a patient who underwent hexagonal keratotomy … More

Top 5 Cataract Surgery Tips for Millennial Surgeons

For the Millennial Eye Live 2019 meeting, I am presenting this talk about my top 5 tips for young surgeons … More

Retained Cortex leads to trouble and macular edema

In this anonymously-submitted case, a small amount of lens cortex was left in the capsular bag at the time of … More

Checking under the Iris for Hidden Cortex

In cases where the pupil does not dilate fully, it can be difficult to see the entire capsular bag to … More

Quiz: What happens with insufficient hydro-dissection?

What happens if the hydro-dissection is insufficient during cataract surgery? The cortex and epi-nuclear shell remain very adherent to the … More

Flip up the epi-nucleus for easy aspiration

In some cataract cases it is helpful to perform hydro-delineation to separate the dense endo-nucleus from the softer epi-nucleus. Once … More

Evaluating Radial Keratotomy for Cataract Surgery

Radial keratotomy (RK) is an out-dated kerato-refractive surgery where radial incisions were made in the cornea in order to cause … More

Needle Puncture for Intumescent White Cataracts

An intumescent white cataract is where the cortex has become opaque and liquified which increases the pressure within the capsular … More

Review: if the chop fails, revert to stop and chop

Sometimes we attempt to use phaco chop to divide the cataract nucleus, but we are just not able to achieve … More

Should we chop in the bag or above the bag?

Should we chop the nucleus within the capsular bag or should we bring the nucleus partially out of the capsular … More

Quiz: A shallowing capsular bag during cortex removal

The irrigation / aspiration probe is placed in the eye and we begin cortex removal. But as we try to … More

Tracing a Circle to make the Capsulorhexis

A very simple technique for new surgeons who are struggling with the capsulorhexis is to trace the intended path with … More

Overlay the keratome to plan out the incision

In all surgeries, you must make the effort to create a great incision, which I have previously described as part … More

What am I thinking while doing cataract surgery?

It’s time for a fun video — what am I thinking while performing cataract surgery? I like the operating room … More

Review: Anterior Vitrectomy & Sulcus IOL Placement

With vitreous prolapsed into the anterior chamber, we must perform a vitrectomy before placing the IOL in the eye. In … More

Beginner Surgeon attempts a dense white cataract

Dense white cataracts are challenging for multiple reasons: the opaque lens blocks any red reflex, the capsular bag may be … More

Calibrating your mental capsulorhexis calipers

Our ideal capsulorhexis will overlap the optic edge for 360 degrees in order to hold the IOL securely in a … More

Optimizing the Red Reflex during Surgery

Illumination through the ophthalmic microscope is important for visualization during cataract surgery. We use a combination of both coaxial and … More

Two-Step Technique for PSC & NS Cataract

We have shown videos for soft posterior subcapsular cataracts where we prolapse the entire lens out of the capsular bag … More

The Chop will not propagate through the cataract

With a dense cataract, a fibrous posterior plate can develop within the lens nucleus. This makes is challenging to split … More

Vertical Chop & Horizontal Chop in the same case

Phaco chop is my preferred method of nucleo-fractis for cataract surgery. It is safe, efficient, and minimally invasive, significantly reducing … More

Review: Adjusting the phaco tip & I/A tip

For coaxial instruments like the phaco probe and the irrigation/aspiration probe, what is the best position for the silicone sleeve … More

Let’s watch a resident perform divide-and-conquer

Many residents choose divide-and-conquer as the first nucleo-fractis technique to learn during residency training. This technique has been featured here … More

Tilt and Chop – a SupraCapsular Technique

Supracapsular phaco techniques are in closer proximity to the corneal endothelium, which can be damaged by the ultrasonic energy from … More

Quiz: What size is this Capsulorhexis?

We want a capsulorhexis to be just large enough to overlap the optic of the IOL in order to hold … More

SupraCapsular Technique for Softer Nuclei

For a relatively soft nucleus, such as in a younger patient with primarily posterior subcapsular cataract changes, the supracapsular technique … More

The Viscoelastic Wave for Dispersive Agents

When we inject the dispersive viscoelastic at the beginning of the case, our goal is to protect the corneal endothelium … More

Adjust the speculum to make access easier

We often will move the positions of our incisions to provide a better result for the patient or a more … More

Review: Making the ideal single plane incision

This is such an important step of cataract surgery that we must review it again as our residents are beginning … More

Removing the last nuclear piece

When we break the cataract nucleus into smaller fragments, we can sometimes have one of these small pieces stuck in … More

Descemet Membrane Endothelial Keratoplasty

The skills learned from cataract surgery, such as working within the anterior chamber and pivoting within the incisions, can be … More

Quiz: Why won’t this nucleus rotate?

This patient has a relatively opaque cataract with a pre-operative vision of only counting fingers. When we go to perform … More

Understanding Force Directions in Phaco Chop

Many resident surgeons find it challenging to learn the technique of phaco chop because of the force vectors which are … More

Adjust the Phaco Probe Angle during Chop

The phaco probe angle changes during the procedure. When we embed the phaco tip into the nucleus, the probe is … More

For wandering eyes, fixate with the chopper

Under topical anesthesia, there are some patients who have a difficult time holding still during critical parts of the surgery … More

Review: How to hydrate and seal the phaco incision

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

Quiz: What is this large central opacity?

Quiz time: What is this large central opacity seen in the anterior chamber? The patient is scheduled for cataract surgery … More

Doing Cataract Surgery on a Cataract Surgeon

It is always an honor when fellow ophthalmologists ask you to perform their cataract surgeries. It can also be stressful … More

Sub-Tenon’s Anesthetic Injection Technique

Placing anesthetic agents in the retro-bulbar space provides excellent anesthesia and akinesia during ocular surgery. We have previously shown the … More

For a Dense Cataract should we fix the astigmatism?

This patient has a dense, white cataract with a pre-op vision of just Counting Fingers at 1 meter (CF at … More

Review: Beginning Surgeon Learns Phaco Chop

You’ve seen countless videos of phaco chop, but you seem to be stuck in a mode of less efficient techniques … More

Quiz: Which eye do you fix first?

This patient needs surgery on both eyes. The right eye has a cataract which is limiting the vision to 20/80 … More

Different 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

The Patient Experience at our Surgery Center

I made a video for patients as a step-by-step guide to the experience having cataract surgery at our surgery center … More

Side View shows the Phaco Probe at a flat angle

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

Foot Pedal Position during Phaco Chop

Learning phaco chop will make your cataract surgeries safer, more efficient, and more enjoyable to perform. And of course, phaco … More

Dense Morgagnian Cataract with Capsule Break

With a Morgagnian cataract, the entire cortex becomes liquified and then the remaining lens nucleus floats within this fluid. In … More

Cataract Surgery in Pseudo-Exfoliation Syndrome

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

What’s on my Cataract Surgery Instrument tray?

In this video I take you through my instrument tray for routine cataract surgery. As you can see in this … More

Review: Divide and Conquer Phaco Technique

Every July, we mark the beginning of the academic year in the USA and this is when our residents progress … More

Tilt and Tumble Phaco Technique

The Tilt and Tumble phaco technique is a very efficient and safe method of nucleus removal. First described many years … More

Guest Surgeon: Pre-Pocket Phaco Incision Technique

Dr. André Berger from São Paulo, Brazil has developed a new technique for creating a corneal phaco incision: the Pre-Pocket … More

Quiz: Why is the posterior capsule wrinkled?

This seemed like a totally routine case. Good incision, good capsulorhexis, efficient nucleus removal, and complete cortex removal. There was … More

Foot Pedal Positions for Learning Phaco Chop

Cataract surgery requires both hands and both feet of the surgeon in order to perform the modern techniques. It seems … More

Cataract surgery after prior trabeculectomy

A well-functioning trabeculectomy surgery is a delicate balance between the aqueous production and the additional outflow via the filtering bleb. … More

External View of Critical Cataract Surgery Steps

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

Review: Basic Principles of Suturing with 10-0 Nylon

I tell my residents that no one is born knowing how to place 10-0 nylon sutures, but rather it is … More

Superior Incision: Hand Position & Microscope Views

While I prefer the temporal approach for routine cataract surgeries, some surgeons prefer a superior incision. Many beginning surgeons who … More

Simultaneous Hand Position and Microscope View

For young ophthalmologists, learning how to hold the instruments and position the hands during cataract surgery can be difficult to … More

Proper Hand Positioning in Cataract Surgery

This is a special video because the camera is focused on my hands for the entire surgery, from placing the … More

Do not retract the phaco probe or you may lose infusion

When we break up the cataract using the phaco chop technique, we can end up with smaller nuclear pieces which … More

Technique for Retrobulbar Anesthetic Injection

To perform a safe cataract surgery and to keep the patient comfortable and pain-free, we need to give a sufficient … More

Review: Learning Grid for Cataract Surgery

July 1 is the beginning of the academic year for our ophthalmology residents and it is an important time to … More

Quiz: What is this white material floating around?

Quiz time: What is this white material as seen in this aphakic eye? The 75 year old patient was noted … More

Analysis of a Resident’s 60th Cataract Surgery

As we get close to starting the academic year in the USA (which runs from July 1, 2019 to June … More

Use the chopper to protect the capsular bag during phaco

The chopper can do so much more than just divide the nucleus into pieces. The chopper can fixate the eye, … More

How big can we make the capsulorhexis?

Just how big can we make the capsulorhexis? It is a balance: the larger the capsulorhexis, the easier it is … More

Quiz: Cataract Surgery in Fuchs’ Corneal Dystrophy

Look carefully at the picture and tell me what you would do differently for this cataract surgery. This patient has … More

Hand Positioning during Cataract Surgery

When performing micro-surgery, particularly intra-ocular surgery like cataract surgery, a high level of precision is required. The surgeon’s hand positioning … More

Review: Solution for the Dense Nuclear Posterior Plate

Looking at this image should intimidate beginning cataract surgeons: this is a whitish-brown totally opaque cataract and it is a … More

Quiz: Why does the red reflex change during surgery?

This is a routine cataract surgery, but there is a limited red reflex during the surgery. This is sometimes due … More

Avoiding Iris Prolapse & Damage in Blue Eyes

We always want to perform a minimally invasive and minimally traumatic cataract surgery. We want to be safe, efficient, and … More