When performing micro-surgery, particularly intra-ocular surgery like cataract surgery, a high level of precision is required. The surgeon’s hand positioning … More
Category: beginning surgeons / novice surgeons
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
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
Posterior Capsule Break with a Toric IOL in the bag
The posterior capsule sustained a break during phaco which was near the capsular bag equator and not immediately noticeable to … 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
Basics: How to Load and Inject a Three-Piece IOL
In the USA, the most commonly used IOL in routine cataract surgery is a single-piece acrylic IOL. These IOLs work … 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 IOL is stuck in the incision! What should we do?
This valuable teaching video was submitted by an anonymous resident who is still in training. In this surgery, a smaller … 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
Technique to suture an IOL to the iris
Sometimes, the IOL can dislocate after surgery and in the case of a three-piece IOL, we can easily suture the … 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
Phaco Chop with Surgeon-Loaded Toric IOL
Yesterday’s video was a complete toric IOL case from marking to alignment, however the IOL was loaded by the technician … 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