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

Review: IntraCameral Medications

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

DMEK surgery with pre-loaded graft

We have previously featured Descemet Membrane Endothelial Keratoplasty here on CataractCoach with a video from one of my residents and … More

Seems like a good chop but…

Another video for our series of Complete Cataract Cases, we present a surgery of me operating. During this surgery, I … More

Cataract Quiz: Rescue this Rhexis!

For this Cataract Quiz we have guest surgeon Dr. Naveen Gopal from Bangalore, India showing us a tough case that … More

Congenital Iris Coloboma Repair

We have another video from master surgeon Dr. Valentin I. Apostolov from Amsterdam. In this video he shows us his … More

Trabeculotomy & Cataract Surgery

Because cataract surgery alone tends to decrease intra-ocular pressure, there is often a benefit of combining it with glaucoma surgery. … More

Resident Surgeon Stop-and-Chop

This is an anonymously submitted video of a resident performing cataract surgery number 60 and the technique is stop-and-chop. This … More

Review: Rule of 9s for Sulcus IOL Power

With newly developed methods of IOL power calculation, we are approaching 90% or higher accuracy of achieving +/- 0.5 D of … More

Pupillary Cerclage Technique

In cases of chronic traumatic mydriasis, we can use sutures to reconstruct a pupil of a reasonable diameter. We have … More

Lens Snare Technique

More than a decade ago in 2009, Dr. Bhattacharya in India described a way of using a lens snare to … More

Cataract Quiz: Why did this IOL decenter?

The patient underwent a combined cataract surgery with pars plana vitrectomy. The cataract surgery went well and even today, 1 … More

Predicting Pseudo-Exfoliation weakeness

We have previously covered the topic of pseudo-exfoliation (PXF) in detail here on CataractCoach. It is an important topic because … More

Do not make a baby capsulorhexis

Making small capsulorhexis makes the cataract surgery more difficult because it limits access to the capsular bag and makes it … More

Review: Why LRIs should be done at the end

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

Secret to Chopping Dense Cataracts

For the phaco chop technique, the nucleus is held stationary by the vacuum level of the phaco probe. This is … More

Cataract Quiz: What’s your next move?

You are performing routine cataract surgery and then you suddenly notice that the posterior capsule is open and a nuclear … More

Ensuring accuracy of A-scan ultrasound

Correlate A-scan & biometry measurements to improve accuracy in IOL calculations. This case shows how disparate measurements can lead to … More

Toric IOL technique with a small pupil

The toric IOL is a great option to address astigmatism at the time of cataract surgery. For the toric IOL … More

How to Enlarge a Small Capsulorhexis

Making a small capsulorhexis can make the cataract surgery more difficult. It becomes challenging to bring nuclear pieces out of … More

Review: Differentiating White Cataracts

You’ve seen the notation in the patient chart: “DWC” which stands for Dense White Cataract, but there is actually a spectrum of cataracts … More

Step-by-step: Malyugin Pupil Ring

To perform cataract surgery in an eye with a small pupil, it helps to expand the pupil to a more … More

How to recover from a capsule rupture

It happens to all surgeons, and it is much more common in beginning surgeons: rupture of the posterior capsule during … More

Cataract Quiz: When did the bag break?

In this anonymously submitted resident video, there is a break in the posterior capsule during cataract surgery. With the assistance … More

Do not withdraw infusion with a capsule break

If there is a break in the posterior capsule, withdrawing the infusion will allow the anterior chamber pressure go to … More

Glaucoma Seton Drainage Surgery

In cases of intractable glaucoma, implanting a seton drainage device can be a very effective therapeutic option. The seton tube … More

Review: Dispersive vs. Cohesive Viscoelastics

Viscoelastics, also referred to as OVDs (ophthalmic visco-surgical devices), are viscous substances that allow us to make phaco-emulsification easier and … More

Capsulorhexis Pivoting

The key to making a great capsulorhexis is understanding the pivoting technique. This allows us to float within the incision … More

Pit Technique for Dense Cataracts

With a dense cataract, there can be a fibrous posterior aspect of the lens nucleus which makes chopping more difficult. … More

Complete Case: Soft Cortical Cataract

Another addition to our series on Complete Cataract Cases is this technique for soft cortical cataracts. These cataracts are typically … More

Capsulorhexis: Good vs Great

In this picture, the capsulorhexis on the left is good because it is centered, continuous, and an appropriate size, but … More

Artificial Intelligence in Ophthalmology

The future is here and John Ladas, MD, PhD gives us a brief lecture about the Rules of the Game … More

Review: Why is Phaco Chop not working?

This patient certainly needs cataract surgery because the dense nucleus has a large degree of central opacity and that has … More

Toric IOL Alignment Dilemma

In this picture, all of these lines are at the 120 degree meridian, so how do you choose where to … More

Leukocoria in a newborn baby

Leukocoria in a newborn baby is an urgent situation that needs immediate attention from an ophthalmologist. The cause of the … More

Cataract Quiz: Where should you make the incision?

Our phaco incisions will induce an astigmatic change in the cornea and we can use that to help achieve a … More

Complete Case: Cataract in a Small Eye

Looking at this picture, we can see that the corneal diameter is very small compared to the size of the … More

How to Evacuate this Hyphema

This patient was struck in the eye with a Champagne cork, which was traveling at a high velocity and hit … More

How to Rescue this Capsulorhexis

We have previously discussed the Little Maneuver which is a method of saving a run away capsulorhexis. In this case, … More

Review: Pseudo-Exfoliation Cataract Surgery

Pseudo-Exfoliation / Small Pupil / Weak Zonules / Shallow AC (watch video below) A sweet 80 year old patient comes … More

Danger: Clear Crescent Red Reflex

When you are mobilizing a dense nucleus and you briefly see a bright, clear, crescent-shaped red reflex, you can be … More

Manual SICS with nucleus bisection

SICS is small incision cataract surgery, and it refers to a method of manual expression of the nucleus through a … More

Cataract Quiz: What happened here?

Look carefully at this picture: what do you see? There is a three-piece IOL in the sulcus and there is … More

The Chopper Push Technique

Watch this video carefully and you will see that the chopper instrument is used just once to create a single … More

Complete Case: Chop in the Bag

Again we have a complete case, from start to finish, showing a routine cataract surgery with a phaco chop technique. … More

You must learn this before finishing residency

The challenge of residency training is that you have just a limited time to learn surgery. You can read books … More

Review: Phaco Incision OCT Analysis

The phaco incision is part of your signature which links you to the patient’s eye forever. Your incision will forever be visible … More

Mentally Recovering from Complications

There are only two types of ophthalmologists who never, ever get surgical complications: (1) those who don’t operate, and (2) … More

Complete Case: Flomax & Toric IOL

Many of our CataractCoach.com readers have been asking for complete cases, shown from start to finish. There is a lot … More

Cataract Quiz: What is hidden in this pic?

Look carefully! There is something that needs to be addressed in this picture — it is not easy to see, … More

Cataract Surgery with Pterygium Present

For a patient with both a pterygium and a visually significant cataract, the best option is usually to do the … More

What are these lines? What is Reflux?

These lines are the posterior capsule which has found its way into the suction port of the I/A probe. We … 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

Posterior Polar without delineation

Posterior polar cataracts are unusual, but certainly every ophthalmologist will see these patients in their own clinics. While most surgeons … More

Posterior Capsule Rupture! Now what?

In this anonymously submitted case from a resident surgeon in training, there are many great lessons to be learned. We … More

How much force for hydro-dissection?

When we perform hydro-dissection, how much force is needed? What volume of balanced salt solution is required? What are the … More

Refining your Surgical Signature

It is so important for surgeons to take pride in their work. You must do a great job, or don’t … More

Setting Up for Cataract Surgery

Cataract surgery is team work and the surgeon is just one member of the team. We need a great team … More

Review: Posterior Capsulorhexis Technique

If there is a central posterior capsule plaque that cannot be removed with the suction from the irrigation/aspiration probe, we … More

Epi-Nucleus Flip Technique

With a thick epi-nuclear shell, it is easier to remove it with the phaco probe as compared to the I/A … More

Fix this Iris Prolapse in 2 seconds

Really. This is not an exaggeration. If you understand the physics of why the iris is prolapsing through the incision, … More

Cataract Quiz: The chop failed. Now what?

Even for expert cataract surgeons, sometimes the attempt at phaco chop fails. This can be due to many reasons and … More

Resident Cataract Case #165 Evaluation

This video is submitted anonymously by a resident ophthalmologist who has completed 164 cataract surgeries so far. This case, his … More

Trap a dense nucleus in order to chop it

With a very dense and fibrous cataract, using just the vacuum from the phaco tip to hold the nucleus is … More

Cortical Cataracts can cause “white-out”

Cortical cataracts occur when some of the lens material becomes liquefied, thereby blocking the visual axis. When we perform hydro-dissection … More

Review: External View of Cataract Surgery Steps

Two of the most critical steps in cataract surgery are the main phaco incision and the capsulorhexis. Properly completing these … More

Phaco Chop in patients over age 90

In previous videos we have explained the differences when operating on nonagenarian patients. These patients have weaker tissues such as … More

Toric IOL planning in a small eye (+29.5 D)

Our main phaco incision will induce astigmatism and multiple variables affect the degree of this change. Larger incisions have more … More

Complete Case: Brunescent & White Cataract

This patient truly needs our help. She developed a cataract in the right eye a few years ago and was … More

The surgeon will struggle to finish. Why?

In this resident surgeon case, the anterior chamber flattens and there is loss of viscoelastic upon attempted manipulation of the … More

The Smallest Permissible Capsulorhexis

From watching our videos, you know that for most cases, I find that a 5 mm capsulorhexis is ideal. This … More

Review: Side View of Hand Position

While we do hold the phaco probe with a pencil grip, we do not use the same angle as writing with … More