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

Analysis of a Resident’s 50th Cataract Surgery (Part 2)

Continuing from the previous post, this is part 2 of 2 of the analysis of a resident’s 50th cataract surgery. … More

Analysis of a Resident’s 50th Cataract Surgery (Part 1)

This is Part 1 of 2 where we are analyzing an anonymous resident’s 50th cataract surgery, which is very early … More

Capsulorhexis in 12 consecutive cataract surgeries

Seeing the same step of surgery performed over and over again can help beginning surgeons learn the subtleties of the … More

Review: 3 Rules for Making Phaco Incisions

Over the last two decades, cataract surgery has evolved from scleral incisions to corneal incisions, from retrobulbar anesthesia to topical … More

Quiz: It’s a good incision so why did the AC collapse?

Quiz time! Watch this brief video carefully and figure out why the anterior chamber collapsed after this resident surgeon made … More

Learning to be consistent: 12 consecutive incisions

We aim to be consistent in our surgeries so that we can make a well-constructed incision each and every time. … More

Anterior Vitrectomy & Sulcus IOL with Optic Capture

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

Collapse of the capsular bag during cortex removal

This is a continuation of the case from yesterday, you can review it here. In that case, the phaco probe … More

The Chop failed because the nuclear halves did not separate

The phaco chop technique is like splitting firewood: the instrument creates the initial cleavage plane which then must be propagated … More

For ultra high myopes, do not aim for plano!

For patients with a large degree of myopia, undergoing cataract surgery can be life changing because in addition to fixing … More

Review: Give the First Surgeon the Benefit of the Doubt

Sometimes you will examine a patient who had surgery elsewhere and you can tell that there were challenges and complications. … More

The ideal Angle of Approach for the phaco incision

The angle of approach of the keratome will determine the tunnel length of our phaco incision. If the angle is … More

Review: How to make a single-plane phaco incision

Many of the more advanced cataract surgeons prefer a single-plane phaco incision because its consistent architecture makes for great sealing. … More

Phaco Fundamentals Part 7: Ultrasound Power Modulations

The phaco ultrasound probe delivers energy into the eye that can be used to break up the cataract to facilitate … More

Review: Complete this case without vitreous prolapse

This is a great learning case from one of our young surgeons in training. The video is 14 minutes long … More

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 … More

Phaco Fundamentals Part 5: Choosing Fluidic Parameters

Now that you have a good understanding of the principals of the fluidics involved in phaco surgery, let’s look at … More

Resident Posterior Polar Cataract with Hydro-Delineation

With a posterior polar cataract, the posterior capsule can be weak, fragile, or even focally absent and this poses challenges … More

Phaco Fundamentals Part 4: Poiseuille’s Equation

Modulating Fluid Flow: Poiseuille’s Equation The basic equation that governs all fluid flow during phacoemulsification surgery is Poiseuille’s Equation. You … More

Ahmed Valve Placement for Neo-Vascular Glaucoma

This patient has a history of severe diabetic eye disease including proliferative retinopathy and prior pan-retinal photocoagulation as well as … More

Phaco Fundamentals Part 3: Peristaltic vs Venturi Pumps

Peristaltic and Venturi Fluid Pumps With modern-day techniques of phaco-assisted aspiration of cataracts, one of the most important concepts in … More

Resident Case: Iris Prolapse during Cataract Surgery

When we encounter iris prolapse in a patient with a light-colored iris, we must be very careful because any iatrogenic … More

Phaco Fundamentals Part 2: Foot Pedal & Inflow/Outflow

Part 2 in our series focuses on the Foot Pedal Position and then balancing Inflow versus Outflow to achieve stable … More

Be Careful if you see the Hole Punch Sign during Phaco

In your first 1000 cataract surgeries, the most common cause of a posterior capsule rupture is iatrogenic damage from the … More

Embed the phaco probe in the nucleus without ultrasound

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

Phaco Fundamentals Part 1: Choosing Steps of Surgery

Every Wednesday, we are going to start a new module to teach Phaco Fundamentals of machine parameters, including fluidics and … More

Converting from Phaco to Manual ECCE Surgery

While it is rare, there are times when it is important to convert from a phaco approach to a manual … More

Position the head so the iris is parallel to the floor

Proper positioning of the patient for cataract surgery is important for the comfort of the patient and the surgeon, but … More

Left-Handed versus Right-Handed with Phaco Incisions

It can be helpful to place our phaco incisions on the steep axis of cornea astigmatism in order to provide … More

Pearls for Using Iris Hooks to Expand Small Pupils

Sometimes, the best approach to expanding a small pupil for cataract surgery is to use iris hooks. These are small, … More

Achieving the State of Flow in Cataract Surgery

The psychological state of Flow is described as “energized focus, full involvement, and enjoyment” of the action being performed. Some … More

White Cataract Posterior Capsule Rupture!

In this anonymous video from a surgeon in training, we have quite the challenge: a dense white cataract surgery where … More

Never make your phaco incision like this!

In this anonymous video we have a phaco incision that is very poorly made. The placement is too far from … More

How to fix Iris Prolapse in Cataract Surgery

In this resident performed surgery, we encounter iris prolapse after too much hydro-dissection. This results in the iris prolapsing out … More

Cataract Surgery after Prior Uveitis Issues

Doing cataract surgery in an eye with a prior history of uveitis can be more challenging than a typical case. … More

What beginner mistakes do you see in this pic?

Learning intra-ocular surgery is not easy and it can take years just to be comfortable with just the basics. Look … More

Proper Form for using a Keratome Safely & Precisely

you must learn proper form for keratome use in cataract surgery

Resident Surgeon Struggles with Phaco Chop

In this anonymous video, a resident surgeon struggles with phaco chop. It is not an easy technique to learn, which … More

Use the Chopper to protect the capsular bag

We work in a very tiny space of just a fraction of a milliliter: the volume of the anterior chamber … More

Understanding Reflux Mode during Phaco

Reflux mode is when you use the foot-pedal to reverse the fluidic pump of your phaco machine. Instead of aspirating … More

use of an AC maintainer in Cataract Surgery

An anterior chamber maintainer is an additional infusion cannula which is inserted via the cornea or limbus in order to … More

Failure to Pivot in the Incision causes Issues

One of the most common mistakes made by novice surgeons is the failure to pivot in the incision. This causes … More

The posterior capsule is wide open – now what?

This is a great learning case from one of our young surgeons in training. The video is 14 minutes long … More

Prevent posterior extension of a capsular break

This is a resident case that you really must learn from, even if you are an expert. During nucleus removal … More

Beginning Surgeon Learns Phaco Chop – so can you!

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

Posterior Polar Cataract by Resident in Training

This is another case of a posterior polar cataract, this time performed by a resident in training. She does a … More

Pre-Chop the Nucleus to Help a Novice Surgeon

Today we have a video of a novice surgeon operating together with an experienced surgeon. The key maneuver in this … More

Resident IFIS / Iris Prolapse Cataract Case

Intra-Operative Floppy Iris Syndrome (IFIS) occurs primarily with the use of systemic tamsulosin (Flomax), a medication that aids in urinary … More

Little Technique to Rescue a Runout Capsulorhexis

The first time that I saw Brian Little, FRCS, FRCOphth demonstrate the technique for rescuing a runout capsulorhexis, I was … More

When to Revert to a Can-Opener Capsulotomy

We have learned from the past two days of videos, that it is sometimes wise to revert to a can-opener … More

Complications from a Failed Capsulorhexis

There is a great deal of learning from this video where a failed capsulorhexis leads to a host of issues … More

A Bad Capsulorhexis leads to Trouble

Today we present another case, submitted by an anonymous surgeon for review. We applaud this surgeon for sharing this complicated … More

Why you MUST learn Phaco-Chop (Resident Case)

A critical part of being an accomplished ophthalmologist is keeping up with the advances in your field. For cataract surgery, … More

For the Capsulorhexis: Femto or Forceps?

Was the capsulorhexis show in this photo done with a femtosecond laser, a micro-pulse electrical zap, or simply with capsule … More

Novice Surgeon attempts a Dense Brunescent Cataract

Today we feature a brave and talented young surgeon who has only about 30 cataracts of experience so far. And … More

Beginning Surgeon Stop-and-Chop Case

We did a survey recently and about 20% of our viewers indicated that they wanted more videos of novice surgeons … More

Draping is an Important Step of Surgery

Though we don’t often show the process of draping for cataract surgery, it is an important step of the procedure. … More

What does the patient actually see?

When we examine patients, we are looking at their eyes and their pathologies from the outside seeing in. We can … More

Bimanual Dexterity Improves Ocular Surgery

I tell my first-year ophthalmology residents to start doing daily tasks such as eating food, shaving, and brushing teeth with … More

Cataract Surgery Learning Grid

During ophthalmology residency, residents are exposed to cataract surgery in steps, starting from the most basic and ending with advanced … More

What I learned about Ophthalmology at age 5

I only remember a few things about kindergarten: playing handball during recess, watching Matilda eat paste, and learning the golden … More

Beginning Surgeon Cataract Case Analysis

Becoming proficient at cataract surgery is not easy and the learning curve is quite steep, particularly at the beginning. We … More

Posterior Capsule Rupture & Anterior Vitrectomy

Early in the learning curve of cataract surgery, beginning surgeons end up with a posterior capsule rupture about 5% of … More