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

Complete Case: Pressurized Cataract

This is an interesting case of a young patient, in his mid 40s, who sustained ocular trauma and developed a … More

Review: 4 quadrant chop-and-conquer

Many ophthalmologists in training start out by learning the four quadrant divide-and-conquer technique, which has a long history of being a … More

Resident Case: improve white cataract chop

In this anonymous video from a resident in Germany, we look to improve the horizontal chop technique in a dense … More

Resident Case: improve stop-and-chop

In this anonymous video from a resident in the USA, we look to improve the stop and chop technique. This … More

Resident Case: improve tilt and chop

In this anonymous video from a resident in Argentina, we look to improve the tilt and chop technique. This young … More

Resident Case: improve vertical chop

In this anonymous video from a resident in India, we look to improve the vertical chop technique. This young surgeon … More

Resident Case: improve horizontal chop

In this anonymous video from a registrar (resident) in the UK, we look to improve the horizontal chop technique. This … More

Resident Case: improve flip and chop

In this anonymous video from a resident in South Korea, we look to improve the flip & chop technique. This … More

Review: Sealing Phaco Incisions

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

climbing up the surgical skill bell curve

Learning surgery, particularly micro-surgery, is very difficult. No one is born knowing how to work within the 0.25 cubic centimeter … More

traumatic cataract with bulging capsule

This 23 year old patient was involved in an accident and developed bilateral traumatic cataracts. When we examine the patient … More

Critiquing my old cataract surgery video

I was digging through some old computer files and I came across an old video that I made in 2006. … More

Resident recovers from capsule break

In the course of learning cataract surgery, resident ophthalmologists will encounter complications such as this posterior capsule rupture. The key … More

Expert Surgeon versus The Rock

There is so much to be learned by watching other surgeons operate. Even after so many thousands of cataract surgeries … More

Which resident will win this contest?

Residents often prefer to learn divide-and-conquer as the first nucleo-fractis technique for phaco surgery. This requires making a central groove … More

Review: 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

You must learn to do MSICS

In many countries where dense, brunescent cataracts are common, the SICS (small incision cataract surgery) or MSICS (manual small incision … More

Soft cataracts can be quite difficult

Most surgeons associate dense cataracts with increasing difficulty during cataract surgery because they require more ultrasonic energy to break up … More

Cataract Quiz: Use the can-opener now?

During capsulorhexis creation, this resident surgeon loses control of the anterior capsule edge and it runs all the way out … More

the hemi-nucleus tuck technique

One of the challenges in phaco surgery is that we need to break up the nucleus in order to remove … More

Removing OVD from behind the IOL

Surgeons in training often ask, “Do I need to remove the viscoelastic from behind the IOL at the end of … More

Draining a choroidal hemorrhage

We recently featured a video of a sudden choroidal hemorrhage which happened during implantation of an IOL. This is a … More

Review: Soft-Shell OVD technique

The Soft-Shell Technique for viscoelastic use in cataract surgery was developed by Dr. Steve Arshinoff as a method of getting the best … More

Learn as I coach this resident

Many ophthalmologists from around the world have asked if we offer a fellowship, externship, or clinical rotation so that they … More

Mastering Divide-and-Conquer

Most young ophthalmologists start learning phacoemulsification cataract surgery with the divide-and-conquer technique. This is an easier technique to learn than … More

Pediatric Posterior Capsulorhexis

Our guest surgeon is Ike K. Ahmed MD from the Prism Eye Institute in the greater Toronto area. He is … More

Dense Cataract Vertical Chop

For a dense cataract, the vertical chop technique works well because the chop will propagate through the nucleus. We have … More

Spiral Capsulorhexis Technique

After needle decompression of the cataract, using a spiral technique for the capsulorhexis has a distinct advantage: if there is … More

Review: if the bag shallows during cortex removal

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

How to: Challenging Uveitic Cataract

This patient has a long standing uveitis which is currently under control as well as uveitic glaucoma which required placement … More

Submarine Chop for dense cataracts

For a dense cataract, performing phaco chop is challenging because the central lens nucleus is so hard that the chop … More

White cataract needle decompression

We know that an intumescent white cataract is fluid-filled with liquefied lens cortex. This makes the pressure within the capsular … More

Wrinkled and fibrotic lens capsule

This seemed like a typical white cataract during the pre-operative exam and when first placed under the surgical microscope on … More

Complete Cataract Case: a very special case

This is a complete cataract case, shown from the making of the first incision to the sealing of the incision. … More

Ruptured Globe: Key Teaching Points

Every ophthalmologist must know how to manage a ruptured globe. In this case it is a corneal laceration with a … More

Review: Surgical Peripheral Iridotomy

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

Small incision glaucoma surgery

This video is amazing — when I first saw this technique, I was in awe because I learned so much. … More

resident divide-and-conquer case 30

An anonymous resident sent in this video of his/her 30th cataract surgery which was done with the divide-and-conquer technique. The … More

Cataract Quiz: Argentinian Flag Sign

Cataract Quiz: How can you prevent the dreaded Argentinian flag sign now? White cataracts can pose a challenge when performing … More

Simplified pterygium technique

There is so much to learn about truly artistic pterygium surgery that we could likely make a PterygiumCoach.com website and … More

Residual posterior polar opacities

We love to show posterior polar cataract videos and we have an entire category for them here on CataractCoach. Using … More

Small pupil, PXF, and IFIS

For a beginning surgeon it is helpful to see surgeons performing techniques that are out of your comfort zone. The … More

Review: Double Capsulorhexis for White Cataracts

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

Pars plana anterior vitrectomy

The only ophthalmologists who have zero surgical complications are those who don’t operate and those who are not fully truthful. … More

Expert level dense white cataract surgery

It is a pleasure to watch a true expert perform his craft and this is especially true for cataract surgery, … More

Quiz: Why are there two main incisions?

Cataract Quiz: Why are there two phaco incisions in this eye? This is a routine cataract surgery and the case … More

Fixing severe capsular phimosis

In a small number of patients, capsular phimosis can happen after cataract surgery. This can lead to severe distortion of … More

Tough posterior capsule opacity

When a patient presents with a dense posterior sub-capsular cataract and there is difficulty removing all of the opacity, how … More

Cataract Surgery in Silicone Oil Eyes

Retina surgeons will occasionally use silicone oil to help keep the retina in position during healing and in rare cases, … More

Review: fixing beginner mistakes

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

The Subtleties of Cataract Surgery

The difference between good cataract surgery and great cataract surgery comes down to subtleties. There are very slight nuances to … More

Bilateral brunescent cataract surgery

This patient has been functionally blind for 10 years and presents to us with bilateral, dense, brunescent cataracts. We must … More

Quiz: What is different about this cataract?

Look carefully at the picture above and you will see something that is different about this white cataract. It is … More

Resident Cataract Surgery Final Exam

Today is June 30 and that is the final day of residency training in the USA since our academic year … More

Analysis of Resident Surgery Steps

This video features side-by-side double camera angles so that we can simultaneously see the microscope view as well as the … More

Fluidic Analysis during Phaco Chop

It can be helpful to see the machine fluidic parameters in real-time as the phaco chop procedure is performed. We … More

Review: capsule attachments with femto-laser

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

Paired Incisions to fix Astigmatism

This is an easy technique that can be so helpful to all cataract surgeons. By using paired phaco incisions, we … More

Pearls for small pupil cataract surgery

There are some great surgical pearls for dealing with small pupils during cataract surgery and this video explains some of … More

Cataract Quiz: Why shift the capsulorhexis?

Looking at the picture above it seems like the capsulorhexis has been shifted nasally: it is much closer to the … More

Complete Case: Cortical Cataract

With a cortical cataract, patients are very symptomatic, particularly if the cortical opacities are within the visual axis. These tend … More

Resident Case Double Camera Angles

For experienced surgeons (which I define as those who have done at least a few thousand cataract surgeries), the microscope … More

Complete Case: a very special patient

As a surgeon, it is always an honor when a colleague trusts you to operate on his eyes or on … More

Review: Cataract surgery after prior RK

This patient was very myopic and desired surgical correction many years before the advent of the excimer laser. As such, … More

Use Trypan Blue dye before OVD

Trypan Blue dye is very useful in cataract surgery because it can stain the anterior lens capsule which improves visualization … More

Complete Case: loose zonular support

Another great video in our series of Complete Cataract Cases: a dense cataract in the setting of loose zonular support. … More

Anterior Capsule Rips Uncontrollably

Quiz time: What do you do when the anterior capsule rips uncontrollably in a young patient who is scheduled to … More

Complete Case: vertical phaco chop

Another complete cataract case, this time showing the vertical chop technique to split the cataract into two halves. This is … More

Resident surgeon does case #100

For all of our young surgeons who are learning cataract surgery, this is a great video because it shows you … More

resident toric IOL case double camera angles

Using double camera angles can help newer surgeons learn the nuances of surgery. This video shows a resident surgeon who … 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

Should you do surgery for this patient?

This is a complex patient who has many systemic medical issues and because her lab tests from this morning showed … More

Complete Case: Efficient Phaco Chop

Another great video in our series of Complete Cataract Cases. You’ll be able to learn from the very first incision … More

Quiz: Should I have used a pupil ring?

This is a tough case and the pupil is smaller than I expected. Should I have used a pupil expansion … More

2 approaches to Posterior Polar Cataracts

Studies have shown that 1 out of 3 posterior polar cataract surgeries result in a ruptured posterior capsule. Here’s the … More

Pre-Chop with just 2 Choppers

Guest surgeon Dr Valentin Apostolov from Amsterdam shows us his technique for splitting a dense nucleus into small fragments before … More

From routine case to disaster in 1 second

When I first saw this video, which was submitted by an anonymous surgeon, I was in disbelief. I simply could … More

Review: The Angle of Approach for Incisions

The angle of approach of the keratome will determine the tunnel length of our phaco incision. If the angle is … More

Tough cataract case for a resident

We are thankful for the many video submissions we receive from our readers, particularly from residents or registrars who are … More

Enlarge the Capsulorhexis

A small capsulorhexis makes nucleus removal more difficult, especially when we have a dense cataract. When the entire lens hardens … More

Complete Case: Floppy Iris & Loose Zonules

There is a benefit to watching a video of a complete cataract case, from start to finish. This is particularly … More

Recovering from Argentinian Flag Sign

We have an entire section devoted to achieving success with white cataracts, including intumescent white cataracts. But even in expert … More

Cataract Surgery in MegaloCornea

This patient has a huge cornea with a diameter of about 14 mm and an equally large anterior segment including … More

Staying calm when you see danger signs

The second that I see this round hole, I know that it is a danger sign. We have previously explained … More

Does cataract surgery pose a viral risk?

Our colleagues from the University of Toronto recently did an experiment to determine if cataract surgery poses a risk of … More

Cataract Quiz: Which direction for capsulorhexis?

In this Cataract Quiz we have a patient with a white cataract and as we start to tear the capsulorhexis, … More

Intra-scleral Gore-Tex IOL fixation

This young patient sustained severe ocular trauma a few years ago and he had a surgical repair done in another … More

Descemet Membrane Detachment

When we make a phaco incision that involves the cornea, there is always a risk of having focal detachment of … More

Double Hydro-Delination Technique

Hydro-delineation is a useful technique which allows us to separate a central endo-nucleus from an epi-nuclear shell. In this case, … More

Lessons from COVID-19

We are now back in our clinics seeing routine patients after almost 2 months of hiatus due to COVID-19. The … More

Cataract Quiz: What do you do now?

This is a complication that is sure to happen to every beginning cataract surgeon: a broken posterior capsule as a … More

Complete Case: PXF supra-capsular chop

The previous case (reference 611) from yesterday, showed the first eye of this patient where the technique was phaco chop … More

Complete Case: PXF chop in the bag

Today (video 611) and tomorrow (video 616) are the two eyes of the same patient who has pseudo-exfoliation syndrome and … More

Hydro-delineation makes chopping easier

Performing hydro-delineation helps to separate the denser, central endo-nucleus from the softer epi-nuclear shell. This endo-nucleus is smaller in diameter, … More

Review: Chopper protects the capsular bag

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

Toric IOL use in Radial Keratotomy

We have featured many videos of cataract surgery in eyes with prior radial keratotomy. Many of these patients seek out … More

Techniques to Open DMEK Grafts

Today was supposed to be the World Cornea Congress in Boston (May 14, 2020) and even though it is cancelled, … More

Fixate the eye with your other hand

The problem with using two hands to hold the capsulorhexis forceps is that you lose the ability to have the … More

Examine instruments before using them

We must examine our instruments before using them to ensure that they are intact and in normal, working condition. In … More

Show me a beautiful cataract surgery

Here on CataractCoach.com we have hundreds of teaching videos, and many of them are of very complex or complicated cases … More

Newbie Resident Cataract Surgery

Even experienced surgeons can learn by watching novice surgeons operate. A nickname for a novice is a newbie since the … More

Review: Embed the phaco tip without ultrasound

This review is particularly important for ophthalmologists who do cataract surgery for patients with mild to moderate nuclear density. This … More

Pre-Chop Variations for Cataract Surgery

In this video, submitted by Dr. Yaun Lin from Casablanca, Morocco, we can learn multiple different variations of Pre-Chop. This … More

Expulsive Choroidal Hemorrhage!

This video is a MUST SEE! An expulsive choroidal hemorrhage is a rare complication than any cataract surgeon must be … More

Cataract Quiz: Chopper breaks zonules

The resident surgeon has good hands and is talented, but like all new surgeons, he is lacking in experience. The … More

Posterior capsule rupture – finish the case

This resident case is a challenge: the posterior capsule is ruptured but there is still cortex to be removed. Can … More

Benchmark: Senior Resident Chop

This is a good benchmark for what a senior resident should be able to achieve by the end of residency … More

Capsulorhexis forceps with ruler marks

Our guest surgeon is Dr. Ron J. Smith who has been instrumental in teaching cataract surgery at UCLA for the … More