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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Crucial lessons learned in residency

A complication during surgery can be a mistake or it can be a lesson. The difference between them is that … More

warning: phaco wound burn!

This is among the most important cataract surgery videos that you will see in your lifetime. Really. I have taught … More

Learning Phaco Chop: you can do it!

Young surgeons need to learn to perform phaco chop — it makes cataract surgery efficient and increases safety. Less ultrasonic … More

posterior chamber deepens with capsule break

When the posterior chamber deepens during cataract surgery, it is usually a sign that the posterior capsule has been ruptured. … More

Surprise! Loose Zonular Support!

This patient has a dense cataract and a surprise waiting for the surgeon: as the nucleus is being cracked, we … 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Capsulorhexis Pivoting

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

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

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

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

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

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

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

Trouble learning phaco chop? Try this first

One of the main reasons why phaco chop is more difficult to learn than divide-and-conquer is that there is a … More

Checking the IOP at the end of surgery

We want to ensure an appropriate intra-ocular pressure (IOP) at the end of surgery. This puts the eye in a … More

Struggling with Phaco Chop? Let me help you

I will be the first to tell you that mastering phaco chop is not easy, but it is certainly worth … More

Phaco Incision Do-Over

In this case, the resident begins by making a phaco incision that is not good. The roof is too thin … More

Recovering from a radialized capsulorhexis

Learning to perform a consistent capsulorhexis is one of the toughest steps of cataract surgery. The anterior capsule is only … More

List of Key Videos for Residents

A young doctor in training asked me to put together a list of key videos prior to her first day … More

Resident Surgeon Learning to do Phaco Chop

In your quest to learn phaco chop, it is helpful to watch other beginning surgeons perform the same technique. In … More

Re-draping the eye makes surgery more efficient

When we place the drapes on the eye and eyelids, it serves to give us better exposure of the surgical … More

It takes new surgeons years to figure this out

This is such a great lesson, that I’m going to limit the text here. Watch the video and learn something … More

Cataract Surgery Lessons from Kyoto

I recently went to Kyoto, Japan for ophthalmology business development projects and I also had a chance to visit a … More

Review: External View of Phaco Chop

Most of the videos on this site are taken through the operating microscope. This gives the view of exactly what … More

Learning Vertical Chop

Vertical chop means that both the phaco probe and the chopper are placed within the capsulorhexis and then both are … More

Making a Scleral Tunnel Phaco Incision

For 99% of my patients, making a corneo-limbal phaco incision is ideal. However, there are cases such as this patient … More

Draping the Eye for Cataract Surgery

Draping the eye is important for cataract surgery. It helps us to create a sterile field and it isolates the … More

Mastering Divide-and-Conquer Phaco

Back by popular demand! Most beginning surgeons start by learning divide-and-conquer as the primary method of nucleus division for cataract … More

Do you really want to learn surgery?

This is one of the most important videos that I have ever made. If you only watch one of my … More

I am thankful for…

Today is Thanksgiving in the USA, which is a holiday in the USA when we give thanks to the people … More

Left-Handed Phaco: What is different?

In this video we review the differences between right-handed phaco and left-handed phaco. As expected, the instruments are held differently, … More

Review: Choosing Phaco Machine Settings

Surgeons often ask about which phaco settings are best. The answer is that it depends on the surgeon, the machine, … More

Watch out for the tubing lines!

This is a simple, but important, lesson: keep the tubing lines and the phaco power cord away from your surgical … More

Review: Learn Horizontal Phaco Chop

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

Evaluation of a resident chop technique

This video was submitted by a resident in Asia who is still learning phaco and has upgraded to using the … More

Does Capsulorhexis direction matter?

Does it matter which way you perform the capsulorhexis? Clockwise or counterclockwise, which is better? What about for right handed … More

How to sculpt a nuclear groove

Sculpting a groove in the nucleus is required for techniques such as divide-and-conquer and stop-and-chop. The groove works best when … More

Resident Stop and Chop Cataract #50

After doing 50 cataract surgeries, most beginning surgeons have developed good technique for the steps of the procedure. For surgeons … More

Review: Angle sweep to remove all OVD

When we fill the eye with viscoelastic, we push it with the greatest force into the opposite angle of the … More

Cataract Surgery Draping is Critical

Watching amazing intra-ocular acrobatics during a challenging cataract case is exciting and makes for a great video, but those cases … More

Close Up: Technique for Phaco Incision

We have shown many videos about the importance of the phaco incision. It is part of the signature that you … More

Capsulorhexis technique with just forceps

In more than 99% of my cataract surgery cases, I do not use a cystotome to start the capsulorhexis. I … More

Surgeon Ergonomics for Ocular Surgery

As an ophthalmic surgeon, you will spend a large part of your future in the operating room performing delicate ocular … More

When should we leave “good enough” alone?

When should we leave “good enough” alone? Ophthalmologists tend to be perfectionists in nature and I certainly fit that description. … More

Review: An easy way to help seal the incision

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

Secrets to Avoid Corneal Edema after Cataract Surgery

Corneal edema can occur after cataract surgery due to a number of factors such as a higher degree of ultrasonic … More

Analysis of a Divide-and-Conquer Cataract Case

This anonymously submitted video is from a surgeon who is 5 years into practice after the culmination of her training. … More

Review: Embed the phaco probe without ultrasound

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

How to Save this Run-Out Capsulorhexis

This case is performed by a junior resident who has done about 20 cases so far. The trouble starts when … More

Lysis of Synechiae and Capsule Staining under Iris

This patient had a prior episode of anterior segment inflammation which caused synechiae to develop, with adhesion of the iris … More

Quiz: Why does this pupil look irregular?

This patient is undergoing a combined cataract surgery with a pars plana vitrectomy. Two novice surgeons are operating: a senior … More

Combined Phaco + MIGS for cataract + glaucoma

Cataract surgery alone is a powerful technique for lowering intra-ocular pressure, particularly in patients with glaucoma. By replacing the 4+ … More

What is the correct way to hold a fluid syringe?

When we have a syringe that is filled with liquid, be it balanced salt solution or visco-elastic, we have a … More

Resident Double Capsulorhexis for White Cataract

We know that intumescent white cataracts have a pressurized capsular bag with the milky white, liquefied cortex material. And we … More

Review: Phaco Incision OCT & Live Video 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

Phaco Chop without using the phaco probe

This is a cataract surgery performed by a resident in training and the patient is known to have Fuchs’ corneal … More

Resident Surgeon takes on a Dense White Cataract

It is a pleasure to show you this video where one of my senior residents performs and excellent cataract surgery … More

Slow motion analysis of posterior capsule rupture

Watching surgical video of cases is very helpful to understand the how and when of the complications of cataract surgery. … More

Quiz: What is the huge danger seen in this photo?

This surgery is being performed by a senior resident and it starts off great. It is a dense white cataract … More

Novice surgeon performs cataract surgery

This video was anonymously submitted by an ophthalmology trainee outside of the USA. He has completed about 90 cataract surgeries … More

Analyzing a resident Stop-and-Chop case

Most of the uncut surgical videos that are shown here are very efficient and complete cases can be performed in … More

Advice for young ophthalmologists for future success

Today we celebrate our 500th post with keen advice for young doctors. We did it. We have published a cataract … More

Milky fluid leaks out of the intumescent cataract

We have explained over the course of many videos that intumescent white cataracts are challenging. One of the primary considerations … More

Cataract Surgery using a Scleral Tunnel Incision

Twenty years ago, when I did my residency training at the Jules Stein Eye Institute at the UCLA School of … More

Top 5 Cataract Surgery Tips for Millennial Surgeons

For the Millennial Eye Live 2019 meeting, I am presenting this talk about my top 5 tips for young surgeons … More

Quiz: What happens with insufficient hydro-dissection?

What happens if the hydro-dissection is insufficient during cataract surgery? The cortex and epi-nuclear shell remain very adherent to the … More

Flip up the epi-nucleus for easy aspiration

In some cataract cases it is helpful to perform hydro-delineation to separate the dense endo-nucleus from the softer epi-nucleus. Once … More

Review: if the chop fails, 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

What am I thinking while doing cataract surgery?

It’s time for a fun video — what am I thinking while performing cataract surgery? I like the operating room … More

Review: Anterior Vitrectomy & Sulcus IOL Placement

With vitreous prolapsed into the anterior chamber, we must perform a vitrectomy before placing the IOL in the eye. In … More

Beginner Surgeon attempts a dense white cataract

Dense white cataracts are challenging for multiple reasons: the opaque lens blocks any red reflex, the capsular bag may be … More

Optimizing the Red Reflex during Surgery

Illumination through the ophthalmic microscope is important for visualization during cataract surgery. We use a combination of both coaxial and … More

Review: Adjusting the phaco tip & 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

Let’s watch a resident perform divide-and-conquer

Many residents choose divide-and-conquer as the first nucleo-fractis technique to learn during residency training. This technique has been featured here … More

Adjust the speculum to make access easier

We often will move the positions of our incisions to provide a better result for the patient or a more … More

Understanding Force Directions in Phaco Chop

Many resident surgeons find it challenging to learn the technique of phaco chop because of the force vectors which are … More

Adjust the Phaco Probe Angle during Chop

The phaco probe angle changes during the procedure. When we embed the phaco tip into the nucleus, the probe is … More

Review: How to hydrate and seal the phaco incision

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

Sub-Tenon’s Anesthetic Injection Technique

Placing anesthetic agents in the retro-bulbar space provides excellent anesthesia and akinesia during ocular surgery. We have previously shown the … More

Review: Beginning Surgeon Learns Phaco Chop

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

Quiz: Which eye do you fix first?

This patient needs surgery on both eyes. The right eye has a cataract which is limiting the vision to 20/80 … More

Different Career Paths for Surgical Learning

The path to learning surgery is a long and challenging one. True success requires years of dedication and the passion … More

Side View shows the Phaco Probe at a flat angle

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

Foot Pedal Position during Phaco Chop

Learning phaco chop will make your cataract surgeries safer, more efficient, and more enjoyable to perform. And of course, phaco … More

What’s on my Cataract Surgery Instrument tray?

In this video I take you through my instrument tray for routine cataract surgery. As you can see in this … More

Review: Divide and Conquer Phaco Technique

Every July, we mark the beginning of the academic year in the USA and this is when our residents progress … More

Tilt and Tumble Phaco Technique

The Tilt and Tumble phaco technique is a very efficient and safe method of nucleus removal. First described many years … More

Foot Pedal Positions for Learning Phaco Chop

Cataract surgery requires both hands and both feet of the surgeon in order to perform the modern techniques. It seems … More

External View of Critical Cataract Surgery Steps

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

Review: Basic Principles of Suturing with 10-0 Nylon

I tell my residents that no one is born knowing how to place 10-0 nylon sutures, but rather it is … More