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