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

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