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

Superior Incision: Hand Position & Microscope Views

While I prefer the temporal approach for routine cataract surgeries, some surgeons prefer a superior incision. Many beginning surgeons who … More

Simultaneous Hand Position and Microscope View

For young ophthalmologists, learning how to hold the instruments and position the hands during cataract surgery can be difficult to … More

Proper Hand Positioning in Cataract Surgery

This is a special video because the camera is focused on my hands for the entire surgery, from placing the … More

Do not retract the phaco probe or you may lose infusion

When we break up the cataract using the phaco chop technique, we can end up with smaller nuclear pieces which … More

Technique for Retrobulbar Anesthetic Injection

To perform a safe cataract surgery and to keep the patient comfortable and pain-free, we need to give a sufficient … More

Review: Learning Grid for Cataract Surgery

July 1 is the beginning of the academic year for our ophthalmology residents and it is an important time to … More

Analysis of a Resident’s 60th Cataract Surgery

As we get close to starting the academic year in the USA (which runs from July 1, 2019 to June … More

Hand Positioning during Cataract Surgery

When performing micro-surgery, particularly intra-ocular surgery like cataract surgery, a high level of precision is required. The surgeon’s hand positioning … More