Four handed phaco! What?

This is a case where we knew ahead of time there would be issues. The patient is mid 50s in … More

Cataract Quiz: First eye predicts the next

This patient had cataract surgery in the first eye a few years ago and when we look at the undilated … More

Recovering from an anterior capsule rip

We have extensively covered the topic of white cataracts here on CataractCoach and we have an entire subcategory devoted to … More

Cataract Quiz: Zonular Dehiscence

Our guest surgeon is Dr Willie Kan from Malaysia and he presents a very tough case: a traumatic white cataract … More

Severe Zonular Laxity in PXF Cataracts

This is a really difficult surgery and we know that ahead of time. When we examine this patient at 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

Capsule Break with I/A and rescue

Our guest surgeon today is Dr Ahmed Al Habash who shows us the best technique of dealing with a posterior … More

Punctured Posterior Capsule Rescue

There are two types of ophthalmologists who do not ever have surgical complications: those who do not operate and those … More

Ruptured Posterior Capsule Recovery

This patient had uneventful cataract surgery in the first eye with placement of a toric trifocal IOL in the capsular … More

This subtle sign indicates weak zonules!

This is a very subtle sign — looking at this title pic, we see a demarcation line just inside the … More

Fixing IOL-induced UGH Syndrome

UGH syndrome is the triad of uveitis, glaucoma, and hyphema which all can be induced as a complication from sulcus … More

Rock the Nucleus in White Cataracts

The topic of white cataracts is so popular here on CataractCoach that we have an entire category devoted to it … More

Cataract Quiz: Why did the trypan do this?

Cataract Quiz: Why did the trypan blue dye do this? Why is the staining so odd looking? Why is the … More

Cataract Quiz: When did the break happen?

This patient has a relatively dense cataract and requires a toric IOL for 2 diopters of regular corneal astigmatism. When … More

Capsular tension rings in PXF

capsular tension rings (CTR) in pseudo-exfoliation (PXF) cataract surgery

Finishing this case will be difficult

The reason why ophthalmologists need to perform at least 1,000 cataract surgeries until they are sufficiently up the learning curve, … More

Cataract Quiz: how to rescue this case

This patient has an intumescent white cataract and we know that poses a risk of capsular run-out due to the … More

tiny pupil and fibrotic membrane

This is a very tough case for this senior resident. The patient has a history of chronic uveitis, which has … More

adherent posterior capsule plaques

You are doing cataract surgery for a patient with a dense nucleus, an advanced cataract, with barely count fingers vision. … More

Cataract Quiz: intumescent decompression

One of our favorite topics on CataractCoach is the intumescent white cataract. We know that the capsular bag is pressurized … More

Cataract Quiz: What happened here?

Our quiz features a video from Gustavo Hüning, MD, MBA from Brazil and it shows an unusual situation that happens … 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

recovering from Argentinian Flag Sign

We have explained in great detail the techniques that can help to prevent the dreaded Argentinian flag sign with intumescent … More

Cataract Quiz: Trapped Air Bubble

We have a great learning case from Dr. Xiaogang Wang from Taiyuan, China with a surgical challenge. This patient has … 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

cannula for cortex aspiration

Bimanual irrigation/aspiration for cortex removal has an advantage: it is easy to switch hands and then access a full 360 … More

Cataract Quiz: many small opacities

Quiz time! You are doing what seemed like a routine cataract case and then you see many small opacities in … More

Cataract Quiz: slight peak of pupil

This is a very subtle sign — look carefully at the picture. In the sub-incisional area, there is a slight … More

recovering from posterior capsule rupture

Every surgeon, no matter how experienced, will experience complications. The rate of complications such as posterior capsule rupture declines substantially … More

Equanimity under Duress

When Sir William Osler left the University of Pennsylvania’s Medical School (the first one in the USA, started in 1765) … More

Intumescent Cataract Auto Aspiration

We know that intumescent white cataracts can be challenging because the lens capsule is pressurized with liquefied lens cortex. This … More

Peeling Capsular Membranes

We present another great learning video from Dr. Val Apostolov from Amsterdam, The Netherlands to show the techniques of peeling … More

Fibrotic Dense White Cataract

This patient developed a white cataract years ago and was unable to seek treatment for a prolonged period of time. … 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

Toric IOL for Posterior Polar Cataracts?

We know that with posterior polar cataracts, there is a congenital weakness in the posterior capsule at the site of … More

Complete Case: Pressurized Cataract

This is an interesting case of a young patient, in his mid 40s, who sustained ocular trauma and developed a … More

traumatic cataract with bulging capsule

This 23 year old patient was involved in an accident and developed bilateral traumatic cataracts. When we examine the patient … 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

Pediatric Posterior Capsulorhexis

Our guest surgeon is Ike K. Ahmed MD from the Prism Eye Institute in the greater Toronto area. He is … More

Spiral Capsulorhexis Technique

After needle decompression of the cataract, using a spiral technique for the capsulorhexis has a distinct advantage: if there is … More

White cataract needle decompression

We know that an intumescent white cataract is fluid-filled with liquefied lens cortex. This makes the pressure within the capsular … More

Wrinkled and fibrotic lens capsule

This seemed like a typical white cataract during the pre-operative exam and when first placed under the surgical microscope on … More

Ruptured Globe: Key Teaching Points

Every ophthalmologist must know how to manage a ruptured globe. In this case it is a corneal laceration with a … More

Cataract Quiz: Argentinian Flag Sign

Cataract Quiz: How can you prevent the dreaded Argentinian flag sign now? White cataracts can pose a challenge when performing … More

Residual posterior polar opacities

We love to show posterior polar cataract videos and we have an entire category for them here on CataractCoach. Using … 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

Fixing severe capsular phimosis

In a small number of patients, capsular phimosis can happen after cataract surgery. This can lead to severe distortion of … More

Tough posterior capsule opacity

When a patient presents with a dense posterior sub-capsular cataract and there is difficulty removing all of the opacity, how … More

Quiz: What is different about this cataract?

Look carefully at the picture above and you will see something that is different about this white cataract. It is … More

Review: capsule attachments with femto-laser

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

Anterior Capsule Rips Uncontrollably

Quiz time: What do you do when the anterior capsule rips uncontrollably in a young patient who is scheduled to … More

From routine case to disaster in 1 second

When I first saw this video, which was submitted by an anonymous surgeon, I was in disbelief. I simply could … 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

Complete Case: Floppy Iris & Loose Zonules

There is a benefit to watching a video of a complete cataract case, from start to finish. This is particularly … More

Recovering from Argentinian Flag Sign

We have an entire section devoted to achieving success with white cataracts, including intumescent white cataracts. But even in expert … More

Staying calm when you see danger signs

The second that I see this round hole, I know that it is a danger sign. We have previously explained … More

Cataract Quiz: What do you do now?

This is a complication that is sure to happen to every beginning cataract surgeon: a broken posterior capsule as a … More

Review: Chopper protects the capsular bag

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

Cataract Quiz: Chopper breaks zonules

The resident surgeon has good hands and is talented, but like all new surgeons, he is lacking in experience. The … 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

Cataract Quiz: Rescue this Rhexis!

For this Cataract Quiz we have guest surgeon Dr. Naveen Gopal from Bangalore, India showing us a tough case that … More

Do not make a baby capsulorhexis

Making small capsulorhexis makes the cataract surgery more difficult because it limits access to the capsular bag and makes it … More

Cataract Quiz: What’s your next move?

You are performing routine cataract surgery and then you suddenly notice that the posterior capsule is open and a nuclear … More

How to Enlarge a Small Capsulorhexis

Making a small capsulorhexis can make the cataract surgery more difficult. It becomes challenging to bring nuclear pieces out of … 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

Cataract Quiz: When did the bag break?

In this anonymously submitted resident video, there is a break in the posterior capsule during cataract surgery. With the assistance … More

Do not withdraw infusion with a capsule break

If there is a break in the posterior capsule, withdrawing the infusion will allow the anterior chamber pressure go to … More

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

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

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

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

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

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

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

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