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

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

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

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 ophthalmologists 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