The use of viscoelastics transformed cataract surgery decades ago. We use the viscoelastic to protect delicate tissues like the corneal … More
Author: Uday Devgan MD
1075: Can I use EDOF with eye disease?
I am frequently asked if the new class of EDOF (extended depth of focus) IOLs can be used in eyes … 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
1062: Playlist: Refractive Issues
The most powerful refractive surgery that we have is cataract surgery. We can address +10 diopters or more of hyperopia, … 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
1058: Quiz: Why did the IOL decenter?
Time for a Cataract Quiz and it features a case sent to us by Dr. Valentin Bachet from Lille, France. … 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
1056: Let’s talk about my OR cases
Recently, on my usual Beverly Hills cataract surgery day, I had a line-up of a bunch of interesting cases and … 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
1051: Fixing the Upside Down IOL
When we inject an IOL, we must ensure that it goes into the eye (either in the capsular bag or … More
1050: complete case: Toric EDOF IOL
This patient is a young man, in his 40s, with a history of cataract development over the last few years. … 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
1011: Opacified IOL Exchange
While it is rare, some IOLs can become opacified with time. This has been reported primarily with hydrophilic acrylic materials … 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
1003: Why did the patient go elsewhere?
This video shows two complete surgeries, both presented at high speed. The original cataract surgery was performed by me and … 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
iris claw lens to address aphakia
Another excellent video from our colleague Dr. Val Apostolov from Amsterdam. In this case there is a patient 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
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