The pre-chop technique refers to mechanically breaking the nucleus into smaller pieces prior to inserting the phaco probe into the … More
Category: beginning surgeons / novice surgeons
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
Review: How to Handle IOL Haptic Twist
When we inject a three-piece acrylic IOL into the eye, we must be very careful to ensure that the IOL … 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 surgeons must learn to load the IOL
The surgeon must know how to do every single part of the surgery, including setting up the phaco machine and … 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
Take Pride in your Cataract Surgery Signature
Many ophthalmologists will perform tens of thousands of cataract surgeries during their careers and each of these procedures can improve … More
Review: How to load and inject a single-piece IOL
Let’s review a routine case, this time with a toric IOL. All surgeons in training must know how to properly … 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
Quiz: What is the Problem that you see here?
This video has been sent to us by an anonymous resident surgeon in training. During this case there was a … 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
Switching from a Toric IOL to a spherical sulcus IOL
We recently featured a four-part series of a single, complicated cataract case in which the phaco probe punctured the posterior … More