Our guest surgeon is Willie Kan, MBBS from Malaysia and he is showing the technique of combined cataract surgery with … More
Author: Uday Devgan MD
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
Recovering from misloaded IOLs
We count on our surgical techs and assistants to help with certain parts of the cataract surgery. One of these … 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
Extended Depth of Focus: Alcon Vivity
We all want to be young again, at least when it comes to vision: visual quality, range of vision, and … 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
Top CataractCoach videos of 2020
As the year comes to an end, we have succeeded in making a new CataractCoach video/post for every day of … 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
IOL design differences
We have many different IOL designs available for use in cataract surgery and even within the most popular category (single-piece, … 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
Twist and Out to Explant IOLs
I first saw Jack Chapman MD explain his technique to explant an IOL at a large ophthalmology meeting about 10 … 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
How to dissect the IOL out of the bag
When we are doing an IOL exchange, the first step is to carefully dissect the old IOL out of 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
Angle Alpha and Angle Kappa with IOLs
If an IOL has zero power, such as in an extremely myopic patient, where we place it in the eye … 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
compilation video: IOL exchange
Every cataract surgeon needs to learn how to perform an IOL exchange because, although it is rare, we sometimes need … 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
compilation video: suture-fixated IOLs
This video features all sorts of suture-fixation techniques for securing IOLs in cases where there is limited or no capsular … 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
Review: Yellow versus Clear Optics
There has been much debate about the light transmission properties of various IOL optic designs. While most IOLs have a … 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