Many ophthalmologists from around the world have asked if we offer a fellowship, externship, or clinical rotation so that they … More
Category: capsulorhexis
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
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
Review: Double Capsulorhexis for White Cataracts
Intumescent white cataracts pose a challenge because the lens cortex has degenerated so much that is has liquefied. This creates … 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
Cataract Quiz: Why shift the capsulorhexis?
Looking at the picture above it seems like the capsulorhexis has been shifted nasally: it is much closer to the … More
Use Trypan Blue dye before OVD
Trypan Blue dye is very useful in cataract surgery because it can stain the anterior lens capsule which improves visualization … More
Enlarge the Capsulorhexis
A small capsulorhexis makes nucleus removal more difficult, especially when we have a dense cataract. When the entire lens hardens … 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
Cataract Quiz: Which direction for capsulorhexis?
In this Cataract Quiz we have a patient with a white cataract and as we start to tear the capsulorhexis, … More
Fixate the eye with your other hand
The problem with using two hands to hold the capsulorhexis forceps is that you lose the ability to have the … More
Capsulorhexis forceps with ruler marks
Our guest surgeon is Dr. Ron J. Smith who has been instrumental in teaching cataract surgery at UCLA for the … 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
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
Capsulorhexis Pivoting
The key to making a great capsulorhexis is understanding the pivoting technique. This allows us to float within the incision … More
Capsulorhexis: Good vs Great
In this picture, the capsulorhexis on the left is good because it is centered, continuous, and an appropriate size, but … 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
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
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
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
The Smallest Permissible Capsulorhexis
From watching our videos, you know that for most cases, I find that a 5 mm capsulorhexis is ideal. This … 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
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
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
Spiral Out Capsulorhexis for Intumescent Cataracts
Some white cataracts are intumescent which means that the capsular bag is filled with liquefied lens cortex. This fluid increases … More
Review: 12 Consecutive Capsulorhexes
Seeing the same step of surgery performed over and over again can help beginning surgeons learn the subtleties 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
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
Review: 1 or 2 hands for the capsulorhexis?
The capsulorhexis is one of the most important and most challenging steps of cataract surgery. When you are performing the … 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
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
I/A probe going under the cortex
Most of the time, we grab the cortex edge under the anterior capsular rim and then we strip centrally. But … More
Challenges with a smaller capsulorhexis
What are the challenges with a somewhat smaller capsulorhexis? In most of my cataract cases, I try to make a … 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
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
Use the Chopper to Lift Nuclear Pieces Up
In cases where the capsulorhexis is small or where the nucleus is particularly large, it can be difficult to bring … 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
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
Why are we making a small capsulorhexis?
In many previous videos, we have explained why it is important to have a sufficiently large capsulorhexis. For an optic … More
How to rescue this capsulorhexis before it runs out
Performing the capsulorhexis is one of the most stressful steps for new ophthalmologists who are beginning to learn cataract surgery. … More
Tracing a Circle to make the Capsulorhexis
A very simple technique for new surgeons who are struggling with the capsulorhexis is to trace the intended path with … More
Calibrating your mental capsulorhexis calipers
Our ideal capsulorhexis will overlap the optic edge for 360 degrees in order to hold the IOL securely in a … More
Two-Step Technique for PSC & NS Cataract
We have shown videos for soft posterior subcapsular cataracts where we prolapse the entire lens out of the capsular bag … More
Quiz: What size is this Capsulorhexis?
We want a capsulorhexis to be just large enough to overlap the optic of the IOL in order to hold … More
For wandering eyes, fixate with the chopper
Under topical anesthesia, there are some patients who have a difficult time holding still during critical parts of the surgery … More
Doing Cataract Surgery on a Cataract Surgeon
It is always an honor when fellow ophthalmologists ask you to perform their cataract surgeries. It can also be stressful … 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
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
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
How big can we make the capsulorhexis?
Just how big can we make the capsulorhexis? It is a balance: the larger the capsulorhexis, the easier it is … 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
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
Opaque Cortical Cataract Cases can be Challenging
The cortical cataract changes look like spokes of a wheel and they can cause issues for both the patient and … 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
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
Review: Do not use the pupil to size the capsulorhexis
Many surgeons use the iris or pupil size as a guide for capsulorhexis creation — but you should not. Do … More
Double Capsulorhexis for Intumescent White Cataract
Intumescent white cataracts pose a challenge because the lens cortex has degenerated so much that is has liquefied. This creates … More
Intentional Capsule Puncture with a Phaco Probe
For intumescent white cataracts we must take special precautions. The capsular bag is fluid-filled and pressurized and there is the … More
Intumescent White Cataract with lots of Milk
This patient has an intumescent white cataract and there is a large volume of liquefied lens cortex. We have shown … 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
The incision and capsulorhexis are your signature
I like to think of the phaco incision and the capsulorhexis as my “signature” on every cataract surgery that I … 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
Cataract Surgery in a younger patient with prior PPV
As we demonstrated recently, cataract surgery in a younger patient (under age 50) can be different than in the typical … More
Double Capsulorhexis to prevent Capsule Run-Out
using the double capsulorhexis technique to deal with an errant tear in cataract surgery
Cataract Surgery and Pars Plana Vitrectomy
There are cases where a patient has both anterior and posterior segment pathology and doing both a cataract surgery plus … 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
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
Avoid Posterior Pressure from the Speculum
We need to place a lid speculum to get the best exposure for cataract surgery, but if we crank it … More
Should you use 2 hands for the capsulorhexis?
The capsulorhexis is one of the most important and most challenging steps of cataract surgery. When you are performing the … 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
Novice Surgeons: Spiral Out the Capsulorhexis
When you watch experienced surgeons doing a capsulorhexis, it looks so easy. The anterior capsule is opened, a flap is … 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
Making the Capsulorhexis without a Cystotome
The classic teaching is to use a cystotome (a sharp, bent 25ga or 27ga needle) to puncture the anterior lens … More
If the view is cloudy, remember the capsulorhexis margins
When the cortex gets opaque, it makes the visualization poor because it blocks the red reflex from retro-illumination. Sometimes, the … 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
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
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
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
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
Flatten the Anterior Lens Capsule with Viscoelastic
Using a Viscoelastic (also called Ophthalmic Visco-surgical Device, or OVD) to flatten the anterior lens capsule is a critical step … More
Hydro-delineate if the Capsulorhexis is too small
Hydro-delineation is a valuable tool particularly in cases where the capsulorhexis is small because it allows us to separate the … 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
Cortical Spokes blocking the view for Capsulorhexis
In this cataract surgery, which is otherwise routine, the cortical spokes of the cataract are blocking the view right … 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
Ocular Fixation during Capsulorhexis
Sometimes, even with systemic sedation, patients can have a strong Bell’s reflex under topical anesthesia and that makes it difficult … More
What is the secret to a perfect capsulorhexis?
When I examine an eye that had previous cataract surgery years ago, I see two things: the incision and 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
Is Femto Phaco worth the Cost?
5 years ago, I posed the question, “Is Femto Phaco a case of the Emperor’s New Clothes?” in an article … More
White Cataract: What is USA Flag Sign? (Hint: Femto)
The USA Flag Sign is seen when we use a femtosecond laser to assist in phaco of a white cataract. (scroll … 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
White Cataract Week is Coming Up!
Sneak Preview: tomorrow is the start of White Cataract Week and we will have a new article and new video … More