1173: phaco aspiration of lens milk

Intumescent white cataracts can pose a problem with capsulorhexis creation. This is because the cortex has liquefied and pressurized the … More

1172: anterior capsular tear in phaco

The lens capsular bag is fragile and very thin, with an anterior measurement of about 14 microns and a posterior … More

1158: adjusting the red reflex

The two primary illumination sources on your microscope are coaxial and paraxial. We have previously explained the differences in the … More

1149: posterior capsulorhexis technique

There are times when it is helpful to perform a posterior capsulorhexis. This is a tricky maneuver because it opens … More

1143: why such a tiny capsulorhexis?

This is the double capsulorhexis technique which is a great choice for intumescent white cataracts. In these types of cases, … More

1142: the ophthalmologist’s wife

This is a complete cataract case, shown start to finish, of a white cataract surgery performed for a patient who … More

1132: Playlist: white cataract capsulorhexis

Performing a successful capsulorhexis is one of the biggest challenges in eyes with white cataracts, particularly intumescent white cataracts. This … More

1122: Remote Capsulorhexis Training

Prof. John Ferris has started a novel program of remotely teaching young surgeons to improve their surgical skills. This can … More

1120: make sure the IOL is centered

We want the IOL optic and the capsulorhexis to both be centered. This is especially important for multifocal IOLs and … More

1057: Resident Double Capsulorhexis

The idea behind the double capsulorhexis is to avoid the capsule run-out (Argentinian Flag Sign) for intumescent white cataracts that … More

1052: Spiral Out Capsulorhexis

Our video features a young and talented surgeon, Dr Priyanka Pantola from Kanpur, UP, India and she is showing us … More

1046: fixing anterior capsule fibrosis

Our usual way of dealing with fibrosis of the anterior lens capsule is to use a sharp instrument such as … More

1040: White Cataract Double Rhexis

Our guest surgeon is Dr. Manbir Singh from India and he is showing us a dense white cataract case with … More

1009: Cutting a Fibrotic Lens Capsule

In some white cataracts, the lens capsule can become fibrotic as the lens cortex becomes absorbed and the capsule contracts. … More

1004: Preventing Capsular Rip in white cataracts

This 30 year old patient has a tough situation: bilateral white cataracts with high pressure within the capsular bag. There … More

white cataract needle decompression

This patient is a good candidate for needle decompression because the intumescent cataract has a distinct fluid layer and we … 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

Playlist: Capsulorhexis

The capsulorhexis is an important step of cataract surgery. It allows us to maintain the strength of the capsular bag … More

Guest surgeon: Milky White Cataract

Our guest surgeon today is Dr Pooja Bhomaj from Miraj, India and she presents a case of a milky white … 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

White Cataract Double Capsulorhexis

It is always a pleasure to learn from a master surgeon like Dr Pradip Mohanta from West Bengal, India. He … 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

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

Small Capsulorhexis Phaco Chop

The capsulorhexis is an important part of cataract surgery and one reason is that it allows access to the inside … More

Not all white cataracts are the same

All white cataracts are not the same. They can run the spectrum from soft to very dense, with a variable … More

expert white cataract capsulorhexis

CataractCoach has advised the beginning surgeons to improve the dexterity of the non-dominant hand and this case is a great … 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

measure the capsulorhexis in high myopia

Eyes come in a spectrum of sizes, particularly with the measurements of the anterior segment in patients with extreme refractive … More

Challenge: Monocular Dense Cataract

Operating on a monocular patient is always stressful since we know that the stakes are higher due to the patient … 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

Capsulorhexis Pearls

By watching many surgeons, we can learn different ways of performing the same procedure. In this case, Dr Luis Escaf … 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

Cataract Quiz: Use the can-opener now?

During capsulorhexis creation, this resident surgeon loses control of the anterior capsule edge and it runs all the way out … More

Learn as I coach this resident

Many ophthalmologists from around the world have asked if we offer a fellowship, externship, or clinical rotation so that they … 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

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