1072: epi-nucleus removal technique

In cases where we perform hydro-delineation and we have a separate epi-nuclear shell to remove, what is the best technique. … More

1061: soft cataracts the easy way

It would seem that performing cataract surgery on an eye with a soft cataract would be easier. Since there is … More

1029: First year in practice Cataract

Our guest surgeon showcases his stop-and-chop nucleo-fractis in a routine cataract surgery and his technique is excellent. He finished his … More

1010: Bimanual Phaco Technique

About 15 years ago, bimanual phaco was relatively popular. The idea is that by separating the infusion from the aspiration, … More

1008: Horizontal Chop Technique

Our guest surgeon is Dr Hafidi Zouheir from Rabat, Morocco and he expertly demonstrates the horizontal chop technique for a … More

white cataract needle decompression

This patient is a good candidate for needle decompression because the intumescent cataract has a distinct fluid layer and we … More

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