The chopper can do so much more than just divide the nucleus into pieces. The chopper can fixate the eye, … More
Category: Cataract Surgery Techniques
Hand Positioning during Cataract Surgery
When performing micro-surgery, particularly intra-ocular surgery like cataract surgery, a high level of precision is required. The surgeon’s hand positioning … More
Review: Solution for the Dense Nuclear Posterior Plate
Looking at this image should intimidate beginning cataract surgeons: this is a whitish-brown totally opaque cataract and it is a … More
Analysis of a Resident’s 50th Cataract Surgery (Part 2)
Continuing from the previous post, this is part 2 of 2 of the analysis of a resident’s 50th cataract surgery. … More
The Most Extreme Myopia that I’ve seen in 20+ years
An average eye has an axial length of about 23 to 24 mm, but this patient had an axial length … More
Review: Fully Separate Nucleus after the Phaco Chop
When doing phaco chop, remember that you must still physically push apart the nuclear halves to achieve complete separation and … More
Guest Surgeon: Chopping a Dense, Leathery Cataract
When we describe a cataract nucleus as leathery, we mean that it is fibrous in nature and our chops and … More
The ideal Angle of Approach for the phaco incision
The angle of approach of the keratome will determine the tunnel length of our phaco incision. If the angle is … More
Review: How to make a single-plane phaco incision
Many of the more advanced cataract surgeons prefer a single-plane phaco incision because its consistent architecture makes for great sealing. … 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
Guest Surgeon teaches us Cataract Surgery Efficiency
We can always learn from fellow surgeons, particularly from those who are truly experts in the field. I recently met … More
What is your ideal Cataract Surgery case? Why?
What is your ideal cataract surgery case? Not your fastest case. Speed does not matter. Efficiency does, but that’s a … More
Review: Four Quadrant Chop-and-Conquer
The idea behind divide-and-conquer makes a lot of sense: divide the nucleus into four quadrants which are more easily phaco-aspirated … More
Review: Cracking the Posterior Plate in a Dense Cataract
With a dense brunescent cataract, one of the primary challenges is cracking the fibrous posterior plate of the nucleus. Using … More
How to Flip Up the Epi-Nucleus for easy removal
Hydro-delineation can be helpful to separate the dense endo-nucleus from the epi-nucleus of the cataract. This makes is a bit … More
Surgical Peripheral Iridotomy using 23g Vitrector
There are times when you will need to make a surgical iridotomy either during cataract surgery or as a stand-alone … More
Embed the phaco probe in the nucleus without ultrasound
The classic teaching for phaco chop and quadrant removal is to embed the phaco probe into the nuclear piece by … More
If your Phaco Chop fails, simply revert to Stop-and-Chop
Sometimes we attempt to use phaco chop to divide the cataract nucleus, but we are just not able to achieve … More
Probe Placement to Facilitate Phaco Chop
Placement of the phaco probe and the chopper are critical to facilitating the phaco chop procedure. One of the big … More
Posterior Polar Cataract with Central Capsule Defect
We have highlighted multiple different posterior polar cataract cases, which warrant reviewing. These include: Soft Posterior Polar in a younger … More
Technique for PSC Cataract Surgery in younger patients
Posterior SubCapsular (PSC) cataracts are more commonly found in our younger patients and in particular, they can cause difficulty with … More
Flip and Chop Phaco is Ideal for Routine Cases
The flip and chop phaco technique has been presented here before on many occasions because it is such an efficient … More
Various Approaches to removing the Epi-Nucleus
When we perform hydro-delineation, we separate the dense endo-nucleus from the relatively soft epi-nucleus. This is helpful in multiple different … More
Understanding Reflux Mode during Phaco
Reflux mode is when you use the foot-pedal to reverse the fluidic pump of your phaco machine. Instead of aspirating … More
What is the secret to patient fixation during surgery?
Many ophthalmologists have asked me how my patients are able to maintain fixation during cataract surgery under topical anesthesia. In … More
Use of a Simcoe Cannula in Cataract Surgery
This video features guest surgeon Rob Melendez MD from New Mexico, USA. Dr. Melendez is a highly talented surgeon with … More
Bimanual Irrigation / Aspiration Technique
Bimanual irrigation / aspiration can be helpful to access a full 360 degrees of cortex, keep the anterior chamber maintained, … More
How to safely remove a nuclear piece near the incision
Sometimes during cataract surgery a small piece of lens material, typically a small nuclear chip, can get stuck in the … More
Expert Technique: Small Pupil & Dense Cataract
Very experienced surgeons never rest — they are always looking to learn more. Like you, I learn a lot from … More
Guest Surgeon: Capsular Bag Power Wash Technique
Our guest surgeon, Dr. Anton A. Eijpe from the Netherlands, demonstrates his technique of capsular bag power washing using balanced … More
Phaco Flip in Post-Vitrectomy and Flomax Cases
Phaco flip has an advantage over other methods of nucleus division: the cataract is already partially out of the capsular … More
I/A Only Technique for a Very Soft Cataract
This patient is young, about 30 years old, and he developed a very dense and large posterior sub-capsular opacity which … More
Horizontal Phaco Chop for Efficient Cataract Surgery
The original phaco chop technique described by Dr. Nagahara in 1995 was the horizontal chop. This involves holding the lens … More
Guest Surgeon: White Cataract Stop-and-Chop
It is good to learn from various techniques from many different surgeons. You get to see the differences and similarities … More
Thank you for our first 200 posts on CataractCoach.com
Today we celebrate the 200th post on CataractCoach.com since we started just 6 months ago. We have kept up with … More
Learning from an External View of Phaco Chop
Most of the videos on this site are taken through the operating microscope. This gives the view of exactly what … More
Flip and Chop for Highly Efficient Cataract Surgery
Phaco flip is an efficient procedure since the initial hydro-dissection brings the nucleus out of the capsular bag. If we … More
Vertical Chop Technique for Efficient Surgery
The vertical chop technique is a favorite of mine, particularly when there is sufficient nuclear density to allow the chop … More
Switching from Vertical Chop to Horizontal Chop
Sometimes cataract surgery is like playing basketball or soccer: you know many different techniques and special moves, but the key … More
Four Quadrant Chop & Conquer Technique
Many ophthalmologist in training start out by learning the four quadrant divide-and-conquer technique, which has a long history of being … More
Why did this Phaco Chop fail to split the cataract?
In order to do a successful phaco chop, we need to make sure that the high vacuum level of the … More
Tips & Tricks for Using Pupil Expansion Devices
While I don’t use them often, pupil expansion devices such as the Malyugin ring, are useful when performing cataract surgery … More
Cracking the Posterior Plate in a Dense Cataract
With a dense brunescent cataract, one of the primary challenges is cracking the fibrous posterior plate of the nucleus. Using … More
One-Chop Technique for Phaco Surgery
For a cataract with moderate nuclear density, splitting the nucleus into two halves can be sufficient for removal with phacoemulsification. … More
Management of the Hemi-Nucleus in Cataract Surgery
Whether you do phaco chop or stop-and-chop, you will be left with two halves of the nucleus which then need … More
Adapting your Phaco Chop Technique to each Eye
I encourage ophthalmologists in training to learn multiple different nucleo-fractis techniques so that they can tailor the cataract surgery to … More
Hydro-Dissection versus Hydro-Delineation
Once the capsulorhexis has been created, it is helpful to use balanced salt solution to loosen and separate the cataract … More
The Adherent Posterior Capsule Plaque
This patient had a long-standing cataract with a very dense 4+ posterior sub-capsular component. Pre-operative vision was barely counting fingers … More
Routine Phaco Chop Cataract Surgery
Continuing with our series about routine cataract cases, today we present a routine phaco chop surgery. The cataract is chopped … More
Routine Flip-and-Chop Cataract Surgery
We have previously featured an instructional video for the Flip-and-Chop method of cataract surgery and there was a very strong … More
Why I love Routine Cataract Cases
Many of the articles and videos here at CataractCoach.com feature unusual, difficult, or challenging cataract cases. These are fun videos … More
Temporal vs Superior Phaco Incisions
[Click link below for full video] Some surgeons prefer to make a superior phaco incision while others prefer a temporal … More
How to remove stubborn sub-incisional cortex
During cataract surgery it is important that we remove all of the lens cortex in order to minimize post-operative inflammation … More
Cataract Surgery in Small, Hyperopic Eyes
Small eyes make cataract surgery more difficult in many ways: there is less working room in the eye, the 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
Rescuing the Radialized Capsulorhexis
The capsulorhexis is an important early step of cataract surgery because it gives strength to the capsular opening so that … More
Soft Cataract Supra-Capsular Technique
How do you approach a soft cataract, such as a posterior sub-capsular or primarily cortical cataract, with very little nuclear … More
Pre-Chopper Technique for Phaco Surgery
The Pre-Chopper instrument was developed by Takayuki Akahoshi MD from Japan and it allows the cataract nucleus to be divided … More
Nucleus Chop with a 27g Cannula
It is the beginning of the academic year, which in the USA runs from July 1 (start) until June 30 … More
Efficient Cataract Surgery for Spastic Patient
Rushing during surgery, especially cataract surgery, is a bad decision. It can lead to complications which can cause a poor … More
Flip and Chop early in the Learning Curve
Phaco Chop is my preferred technique of nucleus removal during cataract surgery because it is safe, efficient, and uses much … More
Cataract Surgery in Fuchs’ Corneal Dystrophy
Fuchs’ endothelial dystrophy is a disorder in which the corneal endothelium becomes progressively weak, leading to corneal decompensation and decreased … More
Basic Principles of Ophthalmic Suturing
I tell my residents that no one is born knowing how to place 10-0 nylon sutures, but rather it is … More
Slow Motion Analysis of Phaco Chop
When we are watching a cataract surgery video to learn techniques from others, it is often difficult to understand the … More
Slow Motion Analysis of Phaco with EDOF IOL
Among our most popular features is the slow motion analysis of cataract surgery: when we slow down the video, we … More
Divide-and-Conquer Technique
To facilitate removal of the cataract nucleus with the phaco probe, it is helpful to divide it into quadrants or … More
Stop-and-Chop Technique for Cataract Surgery
The Stop-and-Chop technique for nucleus removal during cataract surgery blends aspects of the Divide-and-Conquer method with some Phaco Chop. Some … More
Another Corneal Laceration with Traumatic Cataract
Another patient presented to our resident ophthalmology clinic with a 1 day history of doing construction work on a roof … 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
Slow Motion Analysis of Cataract Surgery
There is a lot to be learned from slow-motion analysis and this applies to cataract surgery as well. Think of … More
Alignment and Centration of Toric Multi-Focal IOLs
[From CataractCoach.com] New technology has given us the ability to address corneal astigmatism and presbyopia with a toric multi-focal IOL. … More
3 tricks for Small Pupil + Flomax Cataract Surgery without Expanders or Iris Hooks
Can you do cataract surgery in an eye with a small pupil without having to use expanders or iris … More
3 Rules for Maneuvering Instruments in the Eye
Intra-ocular procedures pose the surgical challenge of working within a very small space with limited room in which to maneuver … More
3 Keys for Cataract Surgery in High Myopes
[From CataractCoach.com – see below for full video] Cataract surgery is arguably the most powerful refractive surgery because the new … More
6 Mistakes that Beginning Cataract Surgeons Make
Learning cataract surgery during ophthalmology residency is critically important for many reasons. It is the most widely performed ophthalmic surgery, … More
3 Rules for making Phaco Incisions
A well-constructed corneal/limbal phaco incision will improve your cataract surgery technique and provide better results for your patient. (scroll down … More
Soft PSC: Posterior Sub-Capsular Cataracts Made Easy
Try this technique to increase safety and provide the best visual outcome for your patients with posterior sub-capsular cataracts. (scroll … More
White Cataract: Solution for the Dense Posterior Nuclear Plate
Looking at this image should intimidate beginning cataract surgeons: this is a whitish-brown totally opaque cataract and it is a … 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 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
Older Surgical Techniques Still Matter
Yes, I love phaco too, but we should all learn to do SICS as well. (Classic ECCE teaching video below) This … More
Successful Posterior Polar Cataract Surgery
Studies have shown that 1 out of 3 posterior polar cataract surgeries result in a ruptured posterior capsule. Here’s the … More
Phaco Flip and Chop Technique
The phaco flip technique is when the nucleus is prolapsed out of the capsular bag and then emulsified at the … More
Cataract Surgery with a Mid-Size Pupil without using iris hooks or expansion devices
How do we do cataract surgery in an eye with a mid-sized pupil of about 3 or 4 mm in … More