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