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

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