Danger: Clear Crescent Red Reflex

When you are mobilizing a dense nucleus and you briefly see a bright, clear, crescent-shaped red reflex, you can be … More

Cataract Quiz: What happened here?

Look carefully at this picture: what do you see? There is a three-piece IOL in the sulcus and there is … More

Mastering IOL Flange Techniques

In cases of insufficient zonular support, using a flange technique has become popular after Dr Shin Yamane shared his technique … More

What are these lines? What is Reflux?

These lines are the posterior capsule which has found its way into the suction port of the I/A probe. We … More

Posterior Capsule Rupture! Now what?

In this anonymously submitted case from a resident surgeon in training, there are many great lessons to be learned. We … More

Review: Posterior Capsulorhexis Technique

If there is a central posterior capsule plaque that cannot be removed with the suction from the irrigation/aspiration probe, we … More

The surgeon will struggle to finish. Why?

In this resident surgeon case, the anterior chamber flattens and there is loss of viscoelastic upon attempted manipulation of the … More

Cataract Quiz: Why is there a capsular wrinkle?

This surgery seemed quite routine. A nice capsulorhexis, easy nucleus removal, and complete cortex clean-up. The three-piece IOL was placed … More

Peeling off a Pupillary Membrane

In this complex case, there is a nearly complete pupillary membrane in an eye with a cataract and a prior … More

Why implant a zero power IOL?

This patient is ultra-myopic with an axial length of more than 31 mm. Using the free calculator at IOLcalc.com we … More

Cataract Quiz: Why is this cortex so adherent?

This seemed like a completely normal case… until it came time for removal of the last bit of cortex, which … More

Two-Handed Capsulorhexis Technique

Our guest surgeon is Ravi Goel MD from New Jersey, USA who is also the author of the ProtectingSight.com blog. … More

Review: Cataract Surgery in Pseudo-Exfoliation

We often encounter patients with Pseudo-Exfoliation Syndrome, often abbreviated as PXF, which makes cataract surgery significantly more challenging. The PXF … More

Cataract Surgery with Synechaie Lysis

Synechiae are adhesions of the iris to ocular structures which can cause issues of aqueous blockage, pupil dilation, and more. … More

What can we learn from the first eye cataract surgery?

The patient had cataract surgery of the right eye two years ago. Initially, she had a plano outcome and great … More

Traumatic Cataract with Mydriasis: Part 2 Pupilloplasty

This patient suffered severe trauma as the result of an airbag injury from a car accident about one year ago. … More

Traumatic Cataract with Mydriasis: Part 1 cataract surgery

This patient suffered severe trauma as the result of an airbag injury from a car accident about one year ago. … More

Severe Capsular Phimosis

Capsular phimosis occurs when there is severe contraction of the anterior capsular tissue which results in a shrinking of the … More

Tear Out of the Anterior Capsule

In this video, which was anonymously submitted, an experienced surgeon encounters a routine cataract case where the anterior capsule is … More

White Cataract with Fibrotic Lens Capsule

This video was submitted by an anonymous surgeon who is attempting this case early in the course of surgical training. … More

Review: YAG laser capsulotomy techniques

Posterior capsule opacification (PCO) is common after cataract surgery. Even a perfect surgery by a master surgeon still leads to … More

Quiz: Cataract & Penetrating Corneal Injury

This patient had a penetrating corneal injury many years ago. When we look at the eye we can see evidence … More

Methods of Capsule Polishing

For polishing of the undersurface of the anterior capsular rim, we can use a friction method with specialized instruments or … More

Quiz: What does this sign mean?

You are just about to start the capsulorhexis and you notice that the anterior lens capsule has straie emanating radially … More

Opacities seen during cataract surgery

In this unusual case we see opacities in the red reflex during cataract surgery. Most of these are within the … More

Capsulorhexis with an anterior capsular plaque

This anterior capsular plaque makes the capsulorhexis creation more challenging. The capsule will not tear predictably in the region of … More

Lysis of Synechiae and Cataract Surgery

In patients with prior uveitis, synechiae between the iris and the anterior lens capsule can develop. These adhesions will prevent … More

Quiz: What is this focal lens opacity?

What is this focal lens opacity that is seen during cataract surgery? And how do we remove it? What likely … More

Quiz: what is different about this white cataract?

This patient has an intumescent white cataract but something is different about this case. In fact, there is a very … More

CTR Technique with less capsular stress

We have featured prior videos about insertion of capsular tension rings (CTRs) during cataract surgery. These devices can be very … More

Quiz: What are these spots seen during surgery?

During cataract surgery for this patient, everything seemed relatively routine. The patient is elderly with some zonular laxity, but even … 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

Does Capsule Polishing prevent capsular opacity?

There has been much debate around the issue of polishing of the undersurface of the anterior capsular rim, yet there … More

Two important danger signs in traumatic cataract

Guest surgeon and expert Ashraf Armia MD shows us two very important danger signs in a traumatic cataract case: wrinkles … More

Surgical Approach to a Traumatic Cataract

When we are faced with a traumatic cataract, there are many factors to consider. The easiest issue is the lens … More

Linear marks seen during cortex removal

For surgeons with just a few years of experience, the part of cataract surgery where a posterior capsule break is … 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

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

Where did the hemi-nucleus go?

This video was submitted by Dr Ravi Prasad Challa from India and it showcases a very rare complication: a break … More

Review: Be Careful if you see the Hole Punch Sign

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

Needle Puncture for Intumescent White Cataracts

An intumescent white cataract is where the cortex has become opaque and liquified which increases the pressure within the capsular … More

Quiz: A shallowing capsular bag during cortex removal

The irrigation / aspiration probe is placed in the eye and we begin cortex removal. But as we try to … More

Capsular Tension Rings in Cataract Surgery

Capsular tension rings are flexible plastic loops which are designed to exert outward force at the capsular bag equator to … More

Dense Morgagnian Cataract with Capsule Break

With a Morgagnian cataract, the entire cortex becomes liquified and then the remaining lens nucleus floats within this fluid. In … More

Cataract Surgery in Pseudo-Exfoliation Syndrome

We often encounter patients with Pseudo-Exfoliation Syndrome, often abbreviated as PXF, which makes cataract surgery significantly more challenging. The PXF … More

Quiz: Why is the posterior capsule wrinkled?

This seemed like a totally routine case. Good incision, good capsulorhexis, efficient nucleus removal, and complete cortex removal. There was … More

Use the chopper to protect the capsular bag during phaco

The chopper can do so much more than just divide the nucleus into pieces. The chopper can fixate the eye, … 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

Guest Surgeon: Cataract with Fibrotic Anterior Capsule

In rare cataract cases, particularly those from prior trauma, we can get fibrosis of the anterior capsule. This makes the … More

Guest Surgeon: Recover from the Argentinian Flag Sign

In our many videos about white cataracts (full series can be found here), we know that one of the biggest … More

Rescue this White Cataract Capsulorhexis

Our CataractCoach.com readers understand the challenges of white cataracts and in particular, intumescent white cataracts. With a capsular bag that … More

Posterior Capsulorhexis for a posterior capsule plaque

If there is a central posterior capsule plaque that cannot be removed with the suction from the irrigation/aspiration probe, we … More

Resident Case: Adherent Posterior Capsule Plaque

Sometimes we can have a plaque of cataract material that is adherent to the central posterior capsule. There are ways … 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

Old IOL explanted, then new IOL sutured to the Iris

This patient had a prior cataract surgery with a single-piece acrylic IOL precariously placed into a compromised capsular bag. This … More

Run Away Capsulorhexis: What is your next move?

This patient has an intumescent white cataract and our surgeon, an ophthalmology resident with about 200 cataract surgeries completed, wishes … More

Incomplete Femtosecond Laser Capsulotomy

We have studied intumescent white cataracts many times here on CataractCoach and we know that the primary challenge is that … 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

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

Traumatic Cataract: What is your approach?

This patient had a traumatic injury to his eye 40 years ago and never sought the care of an ophthalmologist … More

Femtosecond Laser Capsulotomy for White Cataracts

With an intumescent white cataract, we know that the capsular bag is filled with fluid — liquefied lens cortex material. … More

Why implant an IOL if the power is Zero?

Sometimes, in a very myopic eye, the desired IOL power will calculate to zero diopters. An IOL of zero diopters … 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

Posterior Polar Cataract with Central Capsule Defect

We have highlighted multiple different posterior polar cataract cases, which warrant reviewing. These include: Soft Posterior Polar in a younger … More

Would you implant a CTR: Capsular Tension Ring?

This challenging cataract case has loose zonular architecture globally, not focally. There is no prior trauma and there is not … More

For loose zonules, bring the nucleus up and out

In this seemingly routine case, we find that the anterior lens capsule wrinkles when we attempt the capsulorhexis. This means … More

Misloaded IOL rips open the posterior capsule

An anonymous surgeon submitted a video of a complication that happened with a misloaded IOL injector. We are thankful for … More

Wrinkled Anterior Lens Capsule – be careful!

poor zonular support cataract surgery

Guest Surgeon: Femto & Capsular Tension Segments

This is a tricky case: a traumatic cataract with extensive zonular loss and weakenss in a younger patient with high … More

Double Capsulorhexis to prevent Capsule Run-Out

using the double capsulorhexis technique to deal with an errant tear in cataract surgery

Be Cautious with the Wrinkly Old Bag

This is one wrinkly old bag! Of course, we are referring to the capsular bag in this cataract surgery. This … More

Ruptured Capsule Rescue & Anterior Vitrectomy

Very important learning case of a posterior capsule ruptured then a rescue including anterior vitrectomy.

Inject more OVD before manipulating the IOL

When we insert the IOL, sometimes viscoelastic will be lost via the main incision. This can happen if we gape … 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

Focal lens opacity after intra-vitreal injection

This patient had multiple prior intra-vitreal injections for macular disease and now presents to you for cataract surgery. Upon examination … 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

Measure the Capsulorhexis for best results

The capsulorhexis is important for successful cataract surgery because it gives the capsular opening strength during cataract removal and allows … More

Pupil Ring placed in one movement, but there is a catch…

I wanted to try a new technique: placing all 4 scrolls of the Malyugin ring on the iris in one … More

Radial Wrinkles mean aspiration of the capsule!

These radial wrinkles emanating from the port of the irrigation/aspiration probe are in the posterior capsule. This happens when we … More

Which direction do you rotate the IOL?

Which way should you rotate the IOL, clockwise or counter-clockwise? The answer is… it depends. If the IOL haptics are … More

Loose Zonules become evident during Capsulorhexis

This is a patient who had an unremarkable pre-operative consultation for cataract surgery, but when we came to the operating … More

Persistent attachments with femto-laser capsulotomy

This young patient (about 40 years old), developed a white cataract which has severely impaired vision in this eye for … More

Routine case, but what’s this line on the capsule?

This is a perfectly routine cataract case and it goes beautifully. But then, at the end of the case with … More

How important is Capsule Polishing in Cataract Surgery?

In modern day cataract surgery, we remove the lens material which keeping the capsular bag to hold the IOL. How … More

Should you try to rescue a dropped nucleus?

For most situations, I recommend that if the cataract nucleus drops into the vitreous cavity due to a ruptured posterior … More

Wait! Is the Posterior Capsule Ruptured?

In this video which was submitted anonymously, the guest surgeon had a routine case with an intact capsulorhexis. But then … More

Traumatic Cataract: What is your surgical approach?

This 42 year old patient sustained an airbag injury to his face a few months ago. He noted cloudy vision … More

Radial Wrinkles are a sign of Weak Zonules

If the zonular structures are intact and normal, the anterior lens capsule should be taut, especially after instillation of viscoelastic. … 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

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

Poor Draping leads to more Complications

This case should be a routine, straightforward surgery with a low chance of complications. But that changes when the draping … More

Please do NOT use the iris to guide Capulorhexis size!

Many surgeons use the iris or pupil size as a guide for capsulorhexis creation — but you should not. Do … More

Pupil Size in Pseudo-Exfoliation Cataract Surgery

Pseudo-exfoliation (PXF) syndrome can make cataract surgery more challenging because of the concomitant issues that exist in these eyes. The … More

Cataract Surgery in Retinitis Pigmentosa

While retinitis pigmentosa is considered a rare disease, it occurs with enough frequency that every cataract surgeon will encounter it … More

Fixing a Radialized Capsulorhexis in manual ECCE

When I first started teaching residents about 20 years ago, we would have the residents do about 10 surgeries of … More

What if the Capsulorhexis is too big?

Ideally, the capsulorhexis diameter should be slightly smaller than the optic diameter so that we can achieve 360° overlap. But … More

Soft Posterior Polar Cataract Technique

This is a patient with a history of high hyperopia (+7.5 of hyperopia) and posterior polar cataracts since childhood. The … More

Cataract Surgery with Traumatic Zonular Loss

Are you ready for a challenge? This patient is a relatively young construction worker who sustained a blunt traumatic ocular … More

The Adherent Posterior Capsule Plaque

This patient had a long-standing cataract with a very dense 4+ posterior sub-capsular component. Pre-operative vision was barely counting fingers … More

Removal of a Posterior Capsule Plaque

When we remove the cataractous lens there is sometimes a posterior plaque that is adherent to the capsule. How do … More

Particles in the Vitreous during Cataract Surgery

These small particles appeared in the anterior vitreous during what appeared to be a routine and uncomplicated cataract surgery. The … More

Surgical Approach for a Morgagnian Cataract

With a white cataract, typically the cortical layers opacify and may partially liquify, and that can make the surgery more … More

Lost Capsulorhexis – here is the Solution

This patient is having cataract surgery but during capsulorhexis creation, the flap edge seems to get lost. And due to … More

Cataract Surgery in Marfan Syndrome

Patients with Marfan Syndrome have a congenital, progressive weakness in the zonular structures which support the crystalline lens. As such, … 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

Preventing and Treating Capsular Phimosis

The capsular bag contracts when we remove the thick cataract (4+ mm thick) and replace it with a thin IOL … More

Rescuing the Radialized Capsulorhexis

The capsulorhexis is an important early step of cataract surgery because it gives strength to the capsular opening so that … More

YAG Laser Capsulotomy Techniques

Posterior capsule opacification (PCO) is common after cataract surgery. Even a perfect surgery by a master surgeon still leads to … More

Recovering from a Hole in the Posterior Capsule

The posterior capsule is very thin (usually about 4μm) and very delicate and in the course of cataract surgery, it … More

Complex Cataract: multiple challenging issues

This patient had a large rhegmatogenous retinal detachment repaired a few years ago with a successful pars plana vitrectomy. The … More

The Curse of the Baby Rhexis

This case is brought to you in conjunction with EyeGuru.org, an excellent resource for both ophthalmologists in training and ophthalmologists … More

3 critical differences in Cataract Surgery for patients over Age 90

    Average life expectancy is at an all-time high in the US at 79, with even better news for … More

Video Review: Posterior Polar Cataract Bowl Technique

This video is from Dr. Ravi Prasad Challa from Hyderabad, India and it shows his bowl technique for performing cataract … More

4 Crucial Tips for Iris Suturing

The iris is unlike any other tissue in the body. It is beautiful and delicate, but it is also tough … More

3 Keys to doing 4-point Sceral-sutured IOLs

From CataractCoach.com: With video footage provided by Dr. Michael Patterson, we review the anterior segment approach to 4-point fixation of an IOL … More

Surgical Approach to the Dislocated IOL

(scroll down for full video of four-point fixation of an IOL to the sclera) Cataract surgery has an amazing success … More

Why did this IOL de-center?

This patient had cataract surgery about 2 months ago with a local ophthalmologist. She did well initially, achieving 20/20 vision … More

White Cataracts: Can you pass the Quiz?

Only a true cataract expert will pass this 2 minute test! The past five articles and videos have all been … More

White Cataract: Capsulorhexis x 2 in the same eye!

Double-Capsulorhexis Approach to the Intumescent White Cataract (Scroll down for the surigcal video of the Capsulorhexis x 2 Technique) The … More

White Cataract: Run-Away Capsulorhexis. Help!

If you’ve done surgery on a patient with a white cataract, you’ve probably experienced the dreaded Argentinian Flag Sign. (Full … More

Pseudo-Exfoliation Cataract Surgery

Pseudo-Exfoliation / Small Pupil / Weak Zonules / Shallow AC   (watch video below) A sweet 80 year old patient comes … More

When the nucleus drops during Cataract Surgery

Every cataract surgeon knows that while complications are rare, if you do a significant volume of surgery, then you’ll certainly … More