This patient is a good candidate for needle decompression because the intumescent cataract has a distinct fluid layer and we … More
Category: Cataract Surgery Techniques
Simplified Pre-Chop Technique
The pre-chop technique refers to mechanically breaking the nucleus into smaller pieces prior to inserting the phaco probe into the … More
The critical step after the chop
There is a critical step after the chop that is absolutely required to facilitate nucleus removal. And this step is … More
Soft Chop technique for soft cataracts
With the amazing results from modern day cataract surgery, many patients are electing to experience the benefits of pseudophakia when … More
Phaco tip bevel down for chop
Many viewers of CataractCoach.com ask me why I prefer to have the phaco tip bevel down for cataract surgery. The … More
Secret to Chopping a Soft Cataract
If the cataract has a minimal amount of nuclear sclerosis, it is more challenging to chop it. The nucleus is … More
Twist and Out to Explant IOLs
I first saw Jack Chapman MD explain his technique to explant an IOL at a large ophthalmology meeting about 10 … More
MSICS in Pseudo-Exfoliation
It is important to learn how to perform MSICS: manual small incision cataract surgery. This is a more evolved and … More
How to dissect the IOL out of the bag
When we are doing an IOL exchange, the first step is to carefully dissect the old IOL out of the … 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
Playlist: Stop-and-Chop Technique
If you are currently performing the Divide-and-Conquer technique of nuclear division, then moving to the Stop-and-Chop technique is relatively easy. … More
Soft versus Dense Cataracts
Our guest surgeon, Dra. Luz Marina Melo from Colombia, shows us two very different techniques for soft versus dense cataracts. … More
Pars Plana Injection of BSS
Our guest surgeon, Dr Mohammad Abusamak from Jordan, is performing cataract surgery on this monocular patient who has a high … More
the bowled out nucleus
We have all experienced it: a nucleus that it too soft and gummy to divide in the capsular bag and … More
Learning Phaco Chop: you can do it!
Young surgeons need to learn to perform phaco chop — it makes cataract surgery efficient and increases safety. Less ultrasonic … More
a short groove is sufficient
For techniques such as stop-and-chop or divide-and-conquer, the phaco probe is used to sculpt a trench or groove in the … More
Rotary Chop Technique
The key to splitting a brunescent cataract is to access the central endo-nucleus. This is the densest part of the … More
Phaco Chop without Vacuum
It is a pleasure to watch an expert surgeon doing cataract surgery and I really enjoyed learning from Dr. Alex … More
Drill and Chop Technique
With a dense cataract, more effort and force is needed to chop the cataract. Usually with phaco chop, it is … More
easily aspirating the epi-nucleus
It is much faster and easier to aspirate the epi-nucleus using the phaco probe than the I/A probe because the … More
remove one nuclear half first
There are many ways to divide and emulsify the lens nucleus in cataract surgery. Some advanced surgeons will chop the … More
scleral tunnel phaco incisions
Many years ago, incisions for cataract surgery were made in the sclera, even for the small phaco incisions. The scleral … More
great learning resident cataract case
If you are in an ophthalmology residency program in the northern hemisphere, particularly in the USA, then you know that … 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
Mastering Stop-and-Chop phaco
Stop-and-chop is a common technique in phaco cataract surgery because it is safe, efficient, and relatively easy to learn. We … More
Lateral Phaco Chop Technqiue
With traditional phaco chop, we place the chopper in front of the phaco probe tip, but there are other options. … More
complete cataract case: phaco flip
The key to the phaco flip technique is using the fluid wave from hydro-dissection to gently prolapse part of the … More
Review: 4 quadrant chop-and-conquer
Many ophthalmologists in training start out by learning the four quadrant divide-and-conquer technique, which has a long history of being a … More
Resident Case: improve stop-and-chop
In this anonymous video from a resident in the USA, we look to improve the stop and chop technique. This … More
Resident Case: improve tilt and chop
In this anonymous video from a resident in Argentina, we look to improve the tilt and chop technique. This young … More
Resident Case: improve vertical chop
In this anonymous video from a resident in India, we look to improve the vertical chop technique. This young surgeon … More
Resident Case: improve flip and chop
In this anonymous video from a resident in South Korea, we look to improve the flip & chop technique. This … More
traumatic cataract with bulging capsule
This 23 year old patient was involved in an accident and developed bilateral traumatic cataracts. When we examine the patient … More
Which resident will win this contest?
Residents often prefer to learn divide-and-conquer as the first nucleo-fractis technique for phaco surgery. This requires making a central groove … More
You must learn to do MSICS
In many countries where dense, brunescent cataracts are common, the SICS (small incision cataract surgery) or MSICS (manual small incision … More
Soft cataracts can be quite difficult
Most surgeons associate dense cataracts with increasing difficulty during cataract surgery because they require more ultrasonic energy to break up … 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
the hemi-nucleus tuck technique
One of the challenges in phaco surgery is that we need to break up the nucleus in order to remove … More
Mastering Divide-and-Conquer
Most young ophthalmologists start learning phacoemulsification cataract surgery with the divide-and-conquer technique. This is an easier technique to learn than … More
Pediatric Posterior Capsulorhexis
Our guest surgeon is Ike K. Ahmed MD from the Prism Eye Institute in the greater Toronto area. He is … More
Dense Cataract Vertical Chop
For a dense cataract, the vertical chop technique works well because the chop will propagate through the nucleus. We have … More
How to: Challenging Uveitic Cataract
This patient has a long standing uveitis which is currently under control as well as uveitic glaucoma which required placement … More
Submarine Chop for dense cataracts
For a dense cataract, performing phaco chop is challenging because the central lens nucleus is so hard that the chop … 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
resident divide-and-conquer case 30
An anonymous resident sent in this video of his/her 30th cataract surgery which was done with the divide-and-conquer technique. The … More
Residual posterior polar opacities
We love to show posterior polar cataract videos and we have an entire category for them here on CataractCoach. Using … More
Paired Incisions to fix Astigmatism
This is an easy technique that can be so helpful to all cataract surgeons. By using paired phaco incisions, we … More
2 approaches to Posterior Polar Cataracts
Studies have shown that 1 out of 3 posterior polar cataract surgeries result in a ruptured posterior capsule. Here’s the … More
Pre-Chop with just 2 Choppers
Guest surgeon Dr Valentin Apostolov from Amsterdam shows us his technique for splitting a dense nucleus into small fragments before … 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
Double Hydro-Delination Technique
Hydro-delineation is a useful technique which allows us to separate a central endo-nucleus from an epi-nuclear shell. In this case, … More
Review: Chopper protects the capsular bag
We work in a very tiny space of just a fraction of a milliliter: the volume of the anterior chamber … More
Review: Embed the phaco tip without ultrasound
This review is particularly important for ophthalmologists who do cataract surgery for patients with mild to moderate nuclear density. This … More
Pre-Chop Variations for Cataract Surgery
In this video, submitted by Dr. Yaun Lin from Casablanca, Morocco, we can learn multiple different variations of Pre-Chop. This … More
Lens Snare Technique
More than a decade ago in 2009, Dr. Bhattacharya in India described a way of using a lens snare to … More
Review: Why LRIs should be done at the end
Limbal relaxing incisions (LRIs) are useful for treating mild to moderate degrees of corneal astigmatism at the time of cataract … More
Pit Technique for Dense Cataracts
With a dense cataract, there can be a fibrous posterior aspect of the lens nucleus which makes chopping more difficult. … More
Complete Case: Soft Cortical Cataract
Another addition to our series on Complete Cataract Cases is this technique for soft cortical cataracts. These cataracts are typically … More
Manual SICS with nucleus bisection
SICS is small incision cataract surgery, and it refers to a method of manual expression of the nucleus through a … More
The Chopper Push Technique
Watch this video carefully and you will see that the chopper instrument is used just once to create a single … More
Epi-Nucleus Flip Technique
With a thick epi-nuclear shell, it is easier to remove it with the phaco probe as compared to the I/A … More
Resident Cataract Case #165 Evaluation
This video is submitted anonymously by a resident ophthalmologist who has completed 164 cataract surgeries so far. This case, his … More
Trap a dense nucleus in order to chop it
With a very dense and fibrous cataract, using just the vacuum from the phaco tip to hold the nucleus is … 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
Phaco Chop in patients over age 90
In previous videos we have explained the differences when operating on nonagenarian patients. These patients have weaker tissues such as … More
Complete Case: Brunescent & White Cataract
This patient truly needs our help. She developed a cataract in the right eye a few years ago and was … More
Review: Side View of Hand Position
While we do hold the phaco probe with a pencil grip, we do not use the same angle as writing with … More
Trouble learning phaco chop? Try this first
One of the main reasons why phaco chop is more difficult to learn than divide-and-conquer is that there is a … More
Checking the IOP at the end of surgery
We want to ensure an appropriate intra-ocular pressure (IOP) at the end of surgery. This puts the eye in a … More
Struggling with Phaco Chop? Let me help you
I will be the first to tell you that mastering phaco chop is not easy, but it is certainly worth … More
How far do you insert the Chopper for Phaco Chop?
A young surgeon who is new to phaco chop asked me how deep to insert the chopper tip into the … More
Highly Efficient Stop-and-Chop
From watching videos here on CataractCoach.com, you’re aware that my favorite method of nucleus division is phaco chop. Any form … More
Flip and Chop in post-PPV eyes
With a prior pars plana vitrectomy, the anterior hyaloid face is gone and therefore there is less support for the … More
Review: 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
Do not vacuum near the corneal endothelium
During cataract surgery, you notice a small lens fragment or an air bubble float up to the corneal endothelium, where … More
The chop failed, so I reverted back to this…
The benefit of learning many different phaco techniques is that you can choose the one that is best for each … More
Mastering Divide-and-Conquer Phaco
Back by popular demand! Most beginning surgeons start by learning divide-and-conquer as the primary method of nucleus division for cataract … More
Phaco Chop in the bag with smaller pupils
In many of the prior videos related to smaller pupils, I have emphasized the technique of bringing the nucleus partially … More
Guest Surgeon “Submarine Chop”
We all learn from each other and today’s video is a great example of that. We are learning from Dr. … More
Cataract Surgery prior to Glaucoma Surgery
We know that this patient will be undergoing glaucoma surgery in the near future and you are doing the cataract … More
Review: Learn Horizontal Phaco Chop
The original phaco chop technique described by Dr. Nagahara in 1995 was the horizontal chop. This involves holding the lens … More
Expert Level Divide-and-Conquer
Many surgeons like the divide-and-conquer technique and it is widely used here in the USA. For young surgeons, it is … 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
How to sculpt a nuclear groove
Sculpting a groove in the nucleus is required for techniques such as divide-and-conquer and stop-and-chop. The groove works best when … More
Learning Surgical Pearls from Colleagues
There are all sorts of surgical pearls that we can learn from our colleagues. Different techniques and methods of making … More
Guest Surgeon: Phaco Chop Technique
This video was anonymously submitted by an experienced surgeon who wants us to analyze the phaco chop technique and give … More
Cataract surgery in Nanophthalmos
Nanophthalmic eyes are very small with a short axial length of less than 20 mm. This makes the cataract surgery … More
Pre-Chopper Phaco Technique
There are many different ways to divide the nucleus during cataract surgery. Phaco of smaller nuclear fragments is easier and … More
CTR Technique with less capsular stress
We have featured prior videos about insertion of capsular tension rings (CTRs) during cataract surgery. These devices can be very … More
When should we leave “good enough” alone?
When should we leave “good enough” alone? Ophthalmologists tend to be perfectionists in nature and I certainly fit that description. … More
Sit temporal but operate using WTR incisions
With-the-rule (WTR) astigmatism is where the steep axis is at or near the 90 degree axis. Placing incisions on the … More
Secrets to Avoid Corneal Edema after Cataract Surgery
Corneal edema can occur after cataract surgery due to a number of factors such as a higher degree of ultrasonic … 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
Learn the Pupil Stretch Technique
Stretching the pupil during cataract surgery is a safe and effective way to improve access via mechanical dilation. While there … More
Review: Embed the phaco probe without ultrasound
The classic teaching for phaco chop and quadrant removal is to embed the phaco probe into the nuclear piece by … More
Guest Surgeon Efficient Divide-and-Conquer
After thousands of cases, surgeons become very efficient and can complete cataract procedures with fewer instruments and less surgical trauma. … More
Surgical Approach to a Traumatic Cataract
When we are faced with a traumatic cataract, there are many factors to consider. The easiest issue is the lens … More
Phaco Chop without using the phaco probe
This is a cataract surgery performed by a resident in training and the patient is known to have Fuchs’ corneal … More
Analyzing a resident Stop-and-Chop case
Most of the uncut surgical videos that are shown here are very efficient and complete cases can be performed in … More
Quiz: For a pupil like this, what is your approach?
With time, young ophthalmologists develop surgical judgment and they are able to look at a case and decide what approach … More
Cataract Surgery using a Scleral Tunnel Incision
Twenty years ago, when I did my residency training at the Jules Stein Eye Institute at the UCLA School of … More
Phaco Flip & Chop is great for Beverly Hills Cataracts
Often, the density of the nucleus and the severity of the cataract relates to the patient’s access to healthcare. In … More
Flip up the epi-nucleus for easy aspiration
In some cataract cases it is helpful to perform hydro-delineation to separate the dense endo-nucleus from the softer epi-nucleus. Once … 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
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
Vertical Chop & Horizontal Chop in the same case
Phaco chop is my preferred method of nucleo-fractis for cataract surgery. It is safe, efficient, and minimally invasive, significantly reducing … More
Let’s watch a resident perform divide-and-conquer
Many residents choose divide-and-conquer as the first nucleo-fractis technique to learn during residency training. This technique has been featured here … More
Tilt and Chop – a SupraCapsular Technique
Supracapsular phaco techniques are in closer proximity to the corneal endothelium, which can be damaged by the ultrasonic energy from … More
SupraCapsular Technique for Softer Nuclei
For a relatively soft nucleus, such as in a younger patient with primarily posterior subcapsular cataract changes, the supracapsular technique … More
Removing the last nuclear piece
When we break the cataract nucleus into smaller fragments, we can sometimes have one of these small pieces stuck in … More
Sub-Tenon’s Anesthetic Injection Technique
Placing anesthetic agents in the retro-bulbar space provides excellent anesthesia and akinesia during ocular surgery. We have previously shown the … More
Review: Beginning Surgeon Learns Phaco Chop
You’ve seen countless videos of phaco chop, but you seem to be stuck in a mode of less efficient techniques … More
Side View shows the Phaco Probe at a flat angle
While we do hold the phaco probe with a pencil grip, we do not use the same angle as writing … More
Foot Pedal Position during Phaco Chop
Learning phaco chop will make your cataract surgeries safer, more efficient, and more enjoyable to perform. And of course, phaco … More
Review: Divide and Conquer Phaco Technique
Every July, we mark the beginning of the academic year in the USA and this is when our residents progress … More
Tilt and Tumble Phaco Technique
The Tilt and Tumble phaco technique is a very efficient and safe method of nucleus removal. First described many years … More
Guest Surgeon: Pre-Pocket Phaco Incision Technique
Dr. André Berger from São Paulo, Brazil has developed a new technique for creating a corneal phaco incision: the Pre-Pocket … More
Foot Pedal Positions for Learning Phaco Chop
Cataract surgery requires both hands and both feet of the surgeon in order to perform the modern techniques. It seems … 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
Review: Basic Principles of Suturing with 10-0 Nylon
I tell my residents that no one is born knowing how to place 10-0 nylon sutures, but rather it is … More
Superior Incision: Hand Position & Microscope Views
While I prefer the temporal approach for routine cataract surgeries, some surgeons prefer a superior incision. Many beginning surgeons who … More
Proper Hand Positioning in Cataract Surgery
This is a special video because the camera is focused on my hands for the entire surgery, from placing the … More
Options for IOL Explant: Twist or Cut
In rare cases, we may need to explant the IOL and replace it with a different IOL for a different … More
Use the chopper to protect the capsular bag during phaco
The chopper can do so much more than just divide the nucleus into pieces. The chopper can fixate the eye, … More
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