The Importance of Networking with your Colleagues

While the professor:resident and mentor:fellow relationships are very valuable for learning in the early stages of your career, you will … More

Review: Cracking the Posterior Plate in a Dense Cataract

With a dense brunescent cataract, one of the primary challenges is cracking the fibrous posterior plate of the nucleus. Using … More

Run Away Capsulorhexis: What is your next move?

This patient has an intumescent white cataract and our surgeon, an ophthalmology resident with about 200 cataract surgeries completed, wishes … More

Incomplete Femtosecond Laser Capsulotomy

We have studied intumescent white cataracts many times here on CataractCoach and we know that the primary challenge is that … More

Phaco Fundamentals Part 3: Peristaltic vs Venturi Pumps

Peristaltic and Venturi Fluid Pumps With modern-day techniques of phaco-assisted aspiration of cataracts, one of the most important concepts in … More

Cataract Surgery after Macula-Off Retinal Detachment

A macula-off retinal detachment usually means a more limited visual prognosis because the critical central vision has been permanently altered … More

How to Flip Up the Epi-Nucleus for easy removal

Hydro-delineation can be helpful to separate the dense endo-nucleus from the epi-nucleus of the cataract. This makes is a bit … More

What IOL Power do you choose for this patient?

This 60 year old patient is seeing you in consultation for cataract surgery. He has a significant posterior subcapsular cataract … More

Review: Do not use the pupil to size the capsulorhexis

Many surgeons use the iris or pupil size as a guide for capsulorhexis creation — but you should not. Do … More

Sometimes Even Experts Struggle during Surgery

As we gain more experience and hone our surgical skills, we achieve the state of flow where the procedure progresses … More

Resident Case: Iris Prolapse during Cataract Surgery

When we encounter iris prolapse in a patient with a light-colored iris, we must be very careful because any iatrogenic … More

Phaco Fundamentals Part 2: Foot Pedal & Inflow/Outflow

Part 2 in our series focuses on the Foot Pedal Position and then balancing Inflow versus Outflow to achieve stable … More

Guest Cataract Surgery: Tiny Pupil with Synechiae

This patient had a prior uveitic episode which resulted in the formation of posterior synechiae, where the iris, at the … More

Position your phaco incision to nick limbal vessels

I saw a patient recently who had femtosecond laser assisted cataract surgery a month prior by an unknown surgeon. The … More

Surgical Peripheral Iridotomy using 23g Vitrector

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

Be Careful if you see the Hole Punch Sign during Phaco

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

Embed the phaco probe in the nucleus without ultrasound

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

Phaco Fundamentals Part 1: Choosing Steps of Surgery

Every Wednesday, we are going to start a new module to teach Phaco Fundamentals of machine parameters, including fluidics and … More

Chopper placement is critical to nucleus division

The placement of the chopper is critically important to achieving division of the cataract nucleus with the phaco chop technique. … More

Converting from Phaco to Manual ECCE Surgery

While it is rare, there are times when it is important to convert from a phaco approach to a manual … More

If your Phaco Chop fails, simply 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

Double Capsulorhexis for Intumescent White Cataract

Intumescent white cataracts pose a challenge because the lens cortex has degenerated so much that is has liquefied. This creates … More

Small Pupil, Dense Cataract, Corneal Scar, Glaucoma

The key to approaching a difficult surgery is to use a stepwise approach. In the case presented here, we have … More

Position the head so the iris is parallel to the floor

Proper positioning of the patient for cataract surgery is important for the comfort of the patient and the surgeon, but … More

The iris/pupil can hold the nucleus during phaco

Today we have an unedited video of a routine case in a patient with floppy iris syndrome due to Flomax … More

Ovoid Pupils in Cataract Surgery – What Happened?

What is happening in these cataract surgery patients with prior Flomax (tamsulosin) use? Why are the pupils ovoid in shape? … More

Left-Handed versus Right-Handed with Phaco Incisions

It can be helpful to place our phaco incisions on the steep axis of cornea astigmatism in order to provide … More

Learning from the IOL Calcs of the First Eye

Even with the best methods of IOL calculations (new generation formulae, artificial intelligence methods, and more), there will still be … More

Traumatic Cataract: What is your approach?

This patient had a traumatic injury to his eye 40 years ago and never sought the care of an ophthalmologist … More

Bleeding in the Anterior Chamber during surgery

It is unusual to encounter bleeding in the anterior chamber during cataract surgery, but rarely it does happen. The typical … More

Intentional Capsule Puncture with a Phaco Probe

For intumescent white cataracts we must take special precautions. The capsular bag is fluid-filled and pressurized and there is the … More

Intumescent White Cataract with lots of Milk

This patient has an intumescent white cataract and there is a large volume of liquefied lens cortex. We have shown … More

Femtosecond Laser Capsulotomy for White Cataracts

With an intumescent white cataract, we know that the capsular bag is filled with fluid — liquefied lens cortex material. … More

IOL Calc Quiz: hitting plano in a high hyperope

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

The incision and capsulorhexis are your signature

I like to think of the phaco incision and the capsulorhexis as my “signature” on every cataract surgery that I … More

Pearls for Using Iris Hooks to Expand Small Pupils

Sometimes, the best approach to expanding a small pupil for cataract surgery is to use iris hooks. These are small, … More

How to Tame Iris Prolapse at the Start of Surgery

When the iris prolapses through the incision, it is due to one principal issue: a gradient whereby the pressure behind … More

Pearls for Using Multi-focal IOLs (bifocal, trifocal)

For now, among the more reliable ways to address presbyopia is implanting a multi-focal IOL. These are typically diffractive in … More

Probe Placement to Facilitate Phaco Chop

Placement of the phaco probe and the chopper are critical to facilitating the phaco chop procedure. One of the big … More

Quiz: Can you spot the potential complication?

In this case, everything seemed routine and it progressed quite smoothly. A nice incision, an accurate capsulorhexis, efficient nucleus removal, … More

Achieving the State of Flow in Cataract Surgery

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

White Cataract Posterior Capsule Rupture!

In this anonymous video from a surgeon in training, we have quite the challenge: a dense white cataract surgery where … More

Never make your phaco incision like this!

In this anonymous video we have a phaco incision that is very poorly made. The placement is too far from … More

Posterior Polar Cataract with Central Capsule Defect

We have highlighted multiple different posterior polar cataract cases, which warrant reviewing. These include: Soft Posterior Polar in a younger … More

IOL Calc Quiz: Why are the eyes so different?

This patient has similar cataracts in both eyes and is preparing for cataract surgery with you. The biometry has been … More

For loose zonules, bring the nucleus up and out

In this seemingly routine case, we find that the anterior lens capsule wrinkles when we attempt the capsulorhexis. This means … More

Cataract Surgery in a younger patient with prior PPV

As we demonstrated recently, cataract surgery in a younger patient (under age 50) can be different than in the typical … More

Technique for PSC Cataract Surgery in younger patients

Posterior SubCapsular (PSC) cataracts are more commonly found in our younger patients and in particular, they can cause difficulty with … More

If your incision has bad construction, try again

As you are making your phaco incision, judge the architecture and if it is not good, then stop and do … More

Suture Complications after Cataract Surgery

Depending on the size and architecture of our incisions for cataract surgery, sutures may be required to ensure adequate closure … More

Optimizing Surgical Flow for Efficiency & Safety

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

Flip and Chop Phaco is Ideal for Routine Cases

The flip and chop phaco technique has been presented here before on many occasions because it is such an efficient … More

Use the Chopper to Push Nuclear Pieces to the Probe

The chopper is used for many different functions during cataract surgery, beyond just chopping the nucleus into smaller fragments. Cataract … More

How to fix Iris Prolapse in Cataract Surgery

In this resident performed surgery, we encounter iris prolapse after too much hydro-dissection. This results in the iris prolapsing out … More

Cataract Surgery after Prior Uveitis Issues

Doing cataract surgery in an eye with a prior history of uveitis can be more challenging than a typical case. … More

Wrinkled Anterior Lens Capsule – be careful!

poor zonular support cataract surgery

Exquisitely sharp blades are needed for eye surgery

The eye is like an under-inflated balloon: the low pressure inside allows it to absorb most jabs without being punctured. … More

What beginner mistakes do you see in this pic?

Learning intra-ocular surgery is not easy and it can take years just to be comfortable with just the basics. Look … More

IOL Calc Quiz: Why such different results?

A fan of CataractCoach has asked for input regarding the IOL calculations for his patient with steep keratometry. When he … More

OCT analysis of Pseudo-Exfoliation Cataracts

Patients with pseudo-exfoliation (PXF) syndrome are known to have deposits of fibrillar material throughout the anterior segment. This is most … More

Various Approaches to removing the Epi-Nucleus

When we perform hydro-delineation, we separate the dense endo-nucleus from the relatively soft epi-nucleus. This is helpful in multiple different … More

Guest Surgeon: Femto & Capsular Tension Segments

This is a tricky case: a traumatic cataract with extensive zonular loss and weakenss in a younger patient with high … More

Double Capsulorhexis to prevent Capsule Run-Out

using the double capsulorhexis technique to deal with an errant tear in cataract surgery

Proper Form for using a Keratome Safely & Precisely

you must learn proper form for keratome use in cataract surgery

Guest Surgeon: Cataract with prior Trabeculectomy

This is a great video submitted by Dr. Mohammed Ghoneem from Alexandria, Egypt where he shows his method for successful … More

Be Cautious with the Wrinkly Old Bag

This is one wrinkly old bag! Of course, we are referring to the capsular bag in this cataract surgery. This … More

Cataract Surgery and Pars Plana Vitrectomy

There are cases where a patient has both anterior and posterior segment pathology and doing both a cataract surgery plus … More

Hydro-delineate for a dense central nucleus

When you see a patient with a dense central endo-nucleus, there are characteristic findings: a lens periphery that is relatively … More

Ruptured Capsule Rescue & Anterior Vitrectomy

Very important learning case of a posterior capsule ruptured then a rescue including anterior vitrectomy.

Resident Surgeon Struggles with Phaco Chop

In this anonymous video, a resident surgeon struggles with phaco chop. It is not an easy technique to learn, which … More

Cataract Surgery in Pigment Dispersion Syndrome

Cataract surgery in patients with Pigment Dispersion Syndrome can be challenging due to the anatomic changes which have happened over … More

Use the Chopper to protect the capsular bag

We work in a very tiny space of just a fraction of a milliliter: the volume of the anterior chamber … More

Understanding Reflux Mode during Phaco

Reflux mode is when you use the foot-pedal to reverse the fluidic pump of your phaco machine. Instead of aspirating … More

use of an AC maintainer in Cataract Surgery

An anterior chamber maintainer is an additional infusion cannula which is inserted via the cornea or limbus in order to … More

Focal lens opacity after intra-vitreal injection

This patient had multiple prior intra-vitreal injections for macular disease and now presents to you for cataract surgery. Upon examination … More

What is the secret to patient fixation during surgery?

Many ophthalmologists have asked me how my patients are able to maintain fixation during cataract surgery under topical anesthesia. In … More

Failure to Pivot in the Incision causes Issues

One of the most common mistakes made by novice surgeons is the failure to pivot in the incision. This causes … More

Use of a Simcoe Cannula in Cataract Surgery

This video features guest surgeon Rob Melendez MD from New Mexico, USA. Dr. Melendez is a highly talented surgeon with … More

The posterior capsule is wide open – now what?

This is a great learning case from one of our young surgeons in training. The video is 14 minutes long … More

Prevent posterior extension of a capsular break

This is a resident case that you really must learn from, even if you are an expert. During nucleus removal … More

Bimanual Irrigation / Aspiration Technique

Bimanual irrigation / aspiration can be helpful to access a full 360 degrees of cortex, keep the anterior chamber maintained, … More

Beginning Surgeon Learns Phaco Chop – so can you!

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

Good versus Bad Corneal Phaco Incisions with OCT

The phaco incision is critical to the success of the cataract surgery. It gives us controlled access to the cataract, … More

How to safely remove a nuclear piece near the incision

Sometimes during cataract surgery a small piece of lens material, typically a small nuclear chip, can get stuck in the … More

Quiz: Should you implant a Toric IOL in this eye?

The patient is 70 years old and the corneal scar of the left eye is about 80% depth within the … More

I missed this Posterior Polar Cataract

This case caught me by surprise: in the pre-operative notes this was listed as a posterior sub-capsular cataract, but when … More

Posterior Polar Cataract by Resident in Training

This is another case of a posterior polar cataract, this time performed by a resident in training. She does a … More

Expert Technique: Small Pupil & Dense Cataract

Very experienced surgeons never rest — they are always looking to learn more. Like you, I learn a lot from … More

Measure the Capsulorhexis for best results

The capsulorhexis is important for successful cataract surgery because it gives the capsular opening strength during cataract removal and allows … More

Why is this patient yelling at me and the staff?

This is a routine cataract surgery that goes well and without complications. What is unusual about this case is the … More

OCT analysis of a corneal phaco incision

For teaching my resident surgeons who are completing their years of ophthalmology training at our UCLA hospitals, we have recently … More

Avoid Posterior Pressure from the Speculum

We need to place a lid speculum to get the best exposure for cataract surgery, but if we crank it … More

Pupil Ring placed in one movement, but there is a catch…

I wanted to try a new technique: placing all 4 scrolls of the Malyugin ring on the iris in one … More

Descemet Detachment at the Phaco Incision

When we construct our corneal phaco incisions, we must be careful to give them the proper architecture and form. We … More

Radial Wrinkles mean aspiration of the capsule!

These radial wrinkles emanating from the port of the irrigation/aspiration probe are in the posterior capsule. This happens when we … More

IOL Calculation Quiz: Ultra-High Myopia

Happy New Year! We are introducing a new feature to CataractCoach.com for 2019: critical evaluation of biometry, IOL calculations, and … More

Why is the pupil peaked during this cataract surgery?

The iris is a fluid tissue that moves within the eye in response to the fluidic changes of cataract surgery. … More

Adjusting the sleeve of the Phaco and 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

Should we do bilateral same-day cataract surgery?

On rare occasions, I will do immediate, bilateral sequential cataract surgery so that a patient can have both right eye … More

After the chop, you must physically separate the nucleus

When doing phaco chop, remember that you must still physically push apart the nuclear halves to achieve complete separation and … More

Should you use 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

Loose Zonules become evident during Capsulorhexis

This is a patient who had an unremarkable pre-operative consultation for cataract surgery, but when we came to the operating … More

Moderate Floppy Iris Syndrome: Avoiding Prolapse

This patient took Flomax (tamsulosin) a few years ago for a brief period of time. He later stopped the medication … More

Cataract Surgeons are Refractive Surgeons

Cataract surgeons are certainly refractive surgeons and we can correct large degrees of myopia, hyperopia, and astigmatism during our lens-based … More

An easy way to help seal the phaco incision

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

How far into the eye do you insert the keratome?

When making your phaco incision, it is important to have the appropriate tunnel length as well as incision width. We … More

Novice Surgeons: Spiral Out the Capsulorhexis

When you watch experienced surgeons doing a capsulorhexis, it looks so easy. The anterior capsule is opened, a flap is … More

Persistent attachments with femto-laser capsulotomy

This young patient (about 40 years old), developed a white cataract which has severely impaired vision in this eye for … More

Routine case, but what’s this line on the capsule?

This is a perfectly routine cataract case and it goes beautifully. But then, at the end of the case with … More

This is why I do LRIs at the end of the case

Limbal relaxing incisions (LRIs) are useful for treating mild to moderate degrees of corneal astigmatism at the time of cataract … More

Pre-Chop the Nucleus to Help a Novice Surgeon

Today we have a video of a novice surgeon operating together with an experienced surgeon. The key maneuver in this … More

Critical Lesson: Giving the Benefit of the Doubt

Sometimes you will examine a patient who had surgery elsewhere and you can tell that there were challenges and complications. … More

Match the Phaco Incision to the Limbal Relaxing Incision

We know that the phaco incision will cause some degree of corneal flattening and this has the ability to alter … More

How important is Capsule Polishing in Cataract Surgery?

In modern day cataract surgery, we remove the lens material which keeping the capsular bag to hold the IOL. How … More

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

Making the Ideal Single-Plane Phaco Incision

Many of the more advanced cataract surgeons prefer a single-plane phaco incision because its consistent architecture makes for great sealing. … More

Guest Surgeon: Capsular Bag Power Wash Technique

Our guest surgeon, Dr. Anton A. Eijpe from the Netherlands, demonstrates his technique of capsular bag power washing using balanced … More

How to Split the Cataract if the Chop is incomplete

Sometimes when we perform phaco chop, the lens does not fully divide. The chop scores and partially splits the nucleus, … More

Complete Toric IOL Case: from Marking to Alignment

Toric IOLs allow us to surgically treat corneal astigmatism at the time of cataract surgery thereby providing our patients with … More

Phaco Flip in Post-Vitrectomy and Flomax Cases

Phaco flip has an advantage over other methods of nucleus division: the cataract is already partially out of the capsular … More

I/A Only Technique for a Very Soft Cataract

This patient is young, about 30 years old, and he developed a very dense and large posterior sub-capsular opacity which … More

Horizontal Phaco Chop for Efficient Cataract Surgery

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

Making the Capsulorhexis without a Cystotome

The classic teaching is to use a cystotome (a sharp, bent 25ga or 27ga needle) to puncture the anterior lens … More

Guest Surgeon: White Cataract Stop-and-Chop

It is good to learn from various techniques from many different surgeons. You get to see the differences and similarities … More

Should you try to rescue a dropped nucleus?

For most situations, I recommend that if the cataract nucleus drops into the vitreous cavity due to a ruptured posterior … More

Wait! Is the Posterior Capsule Ruptured?

In this video which was submitted anonymously, the guest surgeon had a routine case with an intact capsulorhexis. But then … More

Hydro-delineate if the Capsulorhexis appears small

In this picture, the capsulorhexis appears to be on the small side, but it is actually just about perfect with … More

IntraCameral Medications during Cataract Surgery

Putting medication directly into the anterior segment of the eye can be very effective. There are many different medications that … More

Thank you for our first 200 posts on CataractCoach.com

Today we celebrate the 200th post on CataractCoach.com since we started just 6 months ago. We have kept up with … More

Use Multiple Small Chops for a Brunescent Cataract

In previous videos, I have shown my technique for breaking up a dense brunescent cataract with a fibrous and tough … More