1076: Playlist: Viscoelastics / OVD

The use of viscoelastics transformed cataract surgery decades ago. We use the viscoelastic to protect delicate tissues like the corneal … More

1074: Angle sweep at the end of phaco

While we need viscoelastic to perform a safe cataract surgery, we do not typically want to leave this OVD inside … More

1073: Why did the AC Depth increase?

This patient had biometry performed in our clinic, using the same machine in 2017 and then again in 2021. Of … More

1072: epi-nucleus removal technique

In cases where we perform hydro-delineation and we have a separate epi-nuclear shell to remove, what is the best technique. … More

1071: Challenging Phaco + DMEK

Prof. Dr. Martin Dirisamer from Munich, Germany is a recognized expert in DMEK surgery and he presents a challenging case … More

1070: Posterior Polar Cortical Cleaving

I really enjoy watching surgical videos from Dr. Neto Rosatelli from Ribeirão Preto, Brazil because he mixes his high degree … More

1069: Playlist: Astigmatism

Cataract surgery is designed to correct the cataract. Refractive cataract surgery is to correct the cataract and also the refractive … More

1068: sutured capsular tension segment

This patient was born with a lens coloboma where part of the crystalline lens did not develop and there is … More

1067: Phaco and iStent Glaucoma device

Cataract surgery alone tends to lower intra-ocular pressure by as much as 25%, which is particularly helpful for patients with … More

1066: senior resident stop-and-chop

This cataract surgery is being performed by a senior resident in the USA (PGY-4 level which means post-graduate year number … More

1065: Cortical Cleaving hydro-dissection

Cortical cleaving hydro-dissection was described 30 years ago by Howard Fine MD, a pioneer in the shift to modern day … More

1064: lessons from 1 year of COVID-10

Just more than a year ago, we had a nationwide shutdown to attempt to curb the spread of COVID-19. This … More

1063: Who is the ideal trifocal patient?

Of course, it goes without saying that you must have a normal cornea, retina, and optic nerve to even be … More

1061: soft cataracts the easy way

It would seem that performing cataract surgery on an eye with a soft cataract would be easier. Since there is … More

1060: Quiz: Why is this so adherent?

Another Cataract Quiz: the case seemed totally normal and without any issues. The IOL is in the capsular bag and … More

1059: Quiz: the case is not done yet

The answer to this Cataract Quiz is seen in the photo above. Look carefully – what do you notice? The … More

1057: Resident Double Capsulorhexis

The idea behind the double capsulorhexis is to avoid the capsule run-out (Argentinian Flag Sign) for intumescent white cataracts that … More

1055: Playlist: 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

1054: complete case: why we chop

You know that I’m a big fan of the phaco chop technique for nucleus disassembly during cataract surgery because it … More

1053: that’s not cortex you’re pulling!

In this anonymously submitted video, we see that if the capsule is inadvertently grabbed by the suction from the I/A … More

1052: Spiral Out Capsulorhexis

Our video features a young and talented surgeon, Dr Priyanka Pantola from Kanpur, UP, India and she is showing us … More

1049: four flanged IOL suture fixation

We have seen a lot of innovation with regards to IOL fixation to the sclera. There is the Yamane technique … More

1048: Playlist: Phaco Efficiency

We have said it many times before, but it still bears repeating: the goal of the surgery is not speed, … More

1047: Complete Cataract Case & Quiz

You start to perform the capsulorhexis and then you notice these wrinkles of the anterior lens capsule. How should you … More

1046: fixing anterior capsule fibrosis

Our usual way of dealing with fibrosis of the anterior lens capsule is to use a sharp instrument such as … More

1045: suturing the IOL to the CTR

Our guest surgeon is Dr. Val Apostolov from Amsterdam and he demonstrates a technique that I have never seen before: … More

1044: sutured capsule support device

Our guest surgeon is Dr. Atul Khadane from Amravati, India and he demonstrates the use of the Assianchor (developed by … More

1043: intra-vitreal injection punctures lens

The most commonly performed ocular invasive procedure performed in the USA is the intra-vitreal injection, with many millions done per … More

1042: you must practice suturing!

If more than 99% of my cataract surgery cases do not require a suture, then why is it so important … More

1041: Playlist: Anterior Vitrectomy

Face the truth: every cataract surgeon encounters an intra-operative complication where an anterior vitrectomy is needed to complete the case. … More

1040: White Cataract Double Rhexis

Our guest surgeon is Dr. Manbir Singh from India and he is showing us a dense white cataract case with … More

1039: complete case: surgeon control

This is a complete cataract case, shown from start to finish, with me as the surgeon. While many of the … More

1038: Recurrent Pterygium Surgery

Removing a pterygium from a virgin eye that has not had prior surgery is relatively straightforward. The pterygium can be … More

1037: Trifocal IOL with white cataract

Trifocal IOLs require refractive accuracy. We need to be able to deliver close to a plano outcome without much residual … More

1036: How to prepare Triamcinolone

Triamcinolone is a longer-acting steroid that is very useful for intra-ocular surgery. We can use it to modulate inflammation, to … More

1035: First year in practice cataract

In keeping with our theme of learning from the cataract surgeries of young surgeons who are at the beginning of … More

1034: Playlist: IntraOp OCT Scan

The intra-operative OCT scan is a rarity in ophthalmic operating rooms because of its cost which can add $60,000 to … More

1033: USA resident’s first phaco chop

This video shows a resident surgeon’s first phaco chop. The key is that the resident is putting the effort to … More

1032: Portugal resident’s first phaco chop

This video shows a resident surgeon’s first phaco chop. The key is that the resident is putting the effort to … More

1031: resident phaco chop critique

Our video is from an anonymous resident surgeon in The Philippines who is performing a phaco chop variant during this … More

1030: Your Surgical Skills at Case 300

Where should your surgical skills be after 300 cases? We have previously explained the learning curve for cataract surgery and … More

1029: First year in practice Cataract

Our guest surgeon showcases his stop-and-chop nucleo-fractis in a routine cataract surgery and his technique is excellent. He finished his … More

1028: Keys to Cataract Surgery Efficiency

If you have performed fewer than 10,000 cataract surgeries, you are still in the part of the learning curve where … More

1027: Playlist: Pseudo-Exfoliation

Cataract surgery in the setting of pseudo-exfolation is particularly challenging due to the structural weakness that occurs with this disease … More

1026: suturing the IOL to the iris

Our guest surgeon shows us his technique for suturing an IOL to the iris in a patient with long-standing peudo-exfoliation … More

1025: Soemmering’s Ring Extraction

Our guest surgeon, Dr Val Apostolov from Amsterdam, is a frequent contributor to CataractCoach and today he shows us a … More

1024: SICS for uveitic cataracts

This is a case of a cataract with extensive synechiae due to prior uveitis. The eye is quiescent now, with … More

1023: Foreign body capsule rupture

This patient sustained a serious ocular injury: a foreign body pierced the cornea, punctured the anterior lens capsule, and now … More

1022: Suprachoroidal hemorrhage

A suprachoroidal hemorrhage is a dreaded complication that can happen with any intra-ocular surgery. We most commonly see it during … More

1021: the nucleus drops during phaco

This anonymously submitted video shows a complication from a resident cataract surgery. The capsulorhexis radializes in the sub-incisional area and … More

1020: Playlist: Complications

Complications happen to all surgeons, no matter how much experience we have. It is true that a surgeon who has … More

1019: from one chop to the next

This complete cataract case shows how we move from the first chop to the next in order to efficiently break … More

1018: the many uses of the chopper

The phaco chopper instrument does more than just chop the nucleus. We use it to pull nuclear pieces out of … More

1017: complete case with dense endo-nucleus

This complete cataract cases features a younger patient who developed bilateral cataracts with a dense endo-nucleus. We also implant a … More

1016: flip and chop in high myopia

This is a patient with a large degree of myopia and a relatively dense cataract. And it is a good … More

1015: phaco flip + chop in pseudo-exfoliation

This complete cataract case features an elderly patient with a dense cataract and pseudo-exfoliation. We use the flip and chop … More

1014: Cataract after prior vitrectomy

This week we are doing complete cataract cases where we will show an entire surgery from start to finish and … More

1013: Playlist: Glaucoma Cases

The most commonly performed glaucoma surgery is…. cataract surgery! We know that doing cataract surgery alone can lower intra-ocular pressure … More

1012: Resident White Cataract Chop

The drive to continually improve our surgical skills starts in residency and then continues for the rest of our careers. … More

1010: Bimanual Phaco Technique

About 15 years ago, bimanual phaco was relatively popular. The idea is that by separating the infusion from the aspiration, … More

1009: Cutting a Fibrotic Lens Capsule

In some white cataracts, the lens capsule can become fibrotic as the lens cortex becomes absorbed and the capsule contracts. … More

1008: Horizontal Chop Technique

Our guest surgeon is Dr Hafidi Zouheir from Rabat, Morocco and he expertly demonstrates the horizontal chop technique for a … More

1007: IOL calculations with retinal disease

Today we present a quick review of IOL selection and calculations when performing cataract surgery on patients with retinal disease. … More

1006: Playlist: Indian Surgeons

Our ophthalmology colleagues from India have brought a high degree of expertise to cataract surgery. Over the past decades, I … More

1005: Resident’s first Anterior Vitrectomy

Every cataract surgeon will experience a ruptured posterior capsule and vitreous prolapse as a complication. The key is to recognize … More

1004: Preventing Capsular Rip in white cataracts

This 30 year old patient has a tough situation: bilateral white cataracts with high pressure within the capsular bag. There … More

1002: Do not upset the iris!

There is a lot to learn from this resident cataract surgery. The case starts out with a reasonable pupil of … More

1001: Ahmed Glaucoma Valve Technique

Our guest surgeon today is Victoria Tseng, MD, PhD who is a glaucoma specialist and professor at the Jules Stein … More

1000 posts/videos on CataractCoach

Back in May of 2018, I had the idea to start CataractCoach.com where I would routinely post about cataract surgery, … More

999: Playlist: Toric IOLs

For the correction of astigmatism at the time of cataract surgery, toric IOLs can be an excellent option. The best … More

I wish I had this book in residency!

“What your medical school and ophthalmology textbooks can’t teach you, but what your mentors, colleagues, and patients will!” That really … More

Capsular Tension Ring Placement

Our guest surgeon is Dr. Bhagyashri Deshmukh from Amravati, India and she is presenting a traumatic cataract case with a … More

highly myopic cataract surgery

These are some of the most rewarding cataract surgeries to perform since we can correct the cataract as well as … More

considerations for monocular patients

Monocular patients present a special situation that can differ from a routine case in a patient with two eyes. We … More

white cataract needle decompression

This patient is a good candidate for needle decompression because the intumescent cataract has a distinct fluid layer and we … More

Playlist: Brazilian Surgeons

The first time I went to Brazil, it was an amazing experience because of the passion. And this applies to … More

Anterior Chamber Phakic IOL removal

Phakic IOLs are useful to address extreme degrees of myopia, but there are potential complications. Previously, we have featured cases … More

Routine Cataract Case for Myopic Patient

Complete Cataract Case: the entire surgery is shown from start to finish, but don’t fret, it is still just a … More

Cataract with Silicone Oil Removal

Our guest surgeon is Willie Kan, MBBS from Malaysia and he is showing the technique of combined cataract surgery with … More

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

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

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

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

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

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

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