1851: Is this posterior subscapsular or polar?

Looks carefully at the picture here and tell me, is that a posterior subscapsular cataract (PSC) or a posterior polar … More

1831: cataract and 8 cut radial keratotomy RK

This is one of the four radial keratotomy patients on whom I operated in the same morning. My practice attracts … More

1820: monocular with pseudo-exfoliation

Ophthalmologists are very familiar with pseudo-exfoliation syndrome since it makes the cataract surgery more challenging due to poor dilation or … More

1818: My Week: Sub-incisional cortex

With sub-incisional cortex, using a bimanual IA set-up makes it relatively easy to remove. However, with a co-axial IA probe, … More

1817: My Week: How do I get the nucleus up?

Many readers have asked for pearls in getting the nucleus up, part way out of the capsular bag, and in … More

1816: My Week: flush out nuclear chips

Every single cataract surgeon who has done at least a few thousand cases has encountered a case with a retained … More

1815: My Week: do not prolapse this nucleus

For many cases, I prefer to partially prolapse the nucleus out of the capsular bag so that it is easier … More

1813: My Week: pseudo-exfoliation case

All this week we will be showing videos of me operating. When I first started CataractCoach in 2018, almost all … More

1793: Visian ICL phakic IOL removal

Phakic lens implants are useful for the treatment of high degrees of myopia which are beyond the capabilities of keratorefractive … More

1765: keep the capsulorhexis centered

In this complete cataract case the pupil has dilated in an asymmetric manner. There is no history of trauma and … More

1764: larger capsulorhexis for larger pupil

This patient has a large anterior segment where the white-to-white diameter is almost 13 mm. He also has a large … More

1762: Focus on Efficiency: putting it all together

This week we have a Focus on Efficiency. Today, putting it all together – a complete case. Over the past … More

1758: Focus on Efficiency: how I think

This week we have a Focus on Efficiency. Today, here is how I think to improve efficiency. This is a … More

1751: for capsule wrinkling, I do this…

This is a complete cataract case, shown start to finish, where the anterior lens capsule wrinkles upon attempted puncture for … More

1731: small eye, shallow AC, high hyperopia

As surgeons, we love it when we can make an incredible improvement in the lives of our patients. An added … More

1722: scleral tunnel for radial keratotomy

I have done cataract surgery for well over 1000 patients with prior radial keratotomy and on a recent surgical line-up, … More

1716: astigmatism in radial keratotomy

For patients with prior radial keratotomy (RK), cataract surgery has to be done differently. These eyes also often have significant … More

1715: capsulorhexis right up against iris

For a case like this where the pupil is mid-dilated to about 5 mm in diameter, be sure to make … More

1706: Approach to the Gummy Nucleus

This patient has a large cortical opacity in the central visual axis which is distorting the vision tremendously. So while … More

1694: nonagenarian pseudo-exfoliation

Cataract surgery is different in nonagenarians as it seems that once the patient reaches age 90, the aging process will … More

1675: soft posterior polar cataract

I enjoy posterior polar cataract surgery because of the challenge. We know that at the site of the polar opacity … More

1674: IOL choice in a teenager

This young patient presents with dense posterior subcapsular (PSC) cataracts in both eyes which is severely limiting the vision. The … More

1673: lift the iris in a small pupil case

For patients with smaller pupils, such as this case with about a 4 mm pupil diameter, I tend not to … More

1672: Where’s the milk?

Not all white cataracts are intumescent with pressurized capsular bags full of liquefied lens cortex. In some cases, like the … More

1660: monocular patient with prior trab

A monocular patient is always a challenge because the patient has just the one eye. This often instills a fear … More

1659: when the anterior capsule wrinkles

Just looking at these two screenshots makes me take a deep breath. The anterior lens capsule is supposed to be … More

1646: posterior polar capsule issue

We have covered the topic of posterior polar cataracts many times before and we even have an entire section on … More

1628: more pearls for highly myopic patients

Highly myopic patients are amazed by cataract surgery because we can address even extreme degrees of myopia while giving great … More

1627: follow up from myopia IOL calcs

I trust that you are enjoying our IOL Calc Case Study videos where we go into the details of interesting … More

1626: considerations for monocular patients

Of the overall cataract surgery volume, perhaps less than 1% of those patients are truly monocular and maybe less than … More

1621: is it ok to do phaco in the AC?

Many years ago when phaco techniques were first being developed, some surgeons elected to do phaco in the anterior chamber. … More

1620: pseudo-exfoliation cataract surgery

When it comes to patients with pseudo-exfoliation (PXF) and cataracts, does the pre-operative examination predict the intra-operative challenges? The title … More

1618: Why did I choose stop-and-chop?

For 22 years, I did a combination of both private practice as well as academics in which I taught the … More

1617: minus power IOLs – meniscus

This patient is so extremely myopic that the IOL power is -2.0 diopters (minus power) in order to leave the … More

1593: this EDOF patient will be amazed

What are the factors for success with EDOF (extended depth of focus) IOLs? How can we ensure that the patient … More

1592: off-axis incisions and toric IOLs

Your surgically induced astigmatism (SIA) from your standard phaco incision is probably far less predictable than you think. There are … More

1591: asteroid hyalosis of the vitreous

We have all seen it before: thousands of small, white, refractile bodies floating in the vitreous cavity with seemingly little … More

1590: flip & chop and clear corneas

This is a complete cataract case, shown start to finish, of a routine cataract surgery using the flip and chop … More

1589: optimzing the incision in RK eyes

The cornea in patients with prior radial keratotomy is very delicate and prone to a higher rate of complications during … More

1566: Ocular Suface & Cataract Surgery

I will be the first to admit that I do not enjoy dealing with ocular surface issues such as dry … More

1565: hesitant to perform flip and chop?

Multiple CataractCoach.com subscribers have emailed me to ask for pearls for success with phaco flip and chop. They have some … More

1564: on-axis incisions for toric IOLs

In most cases, I like to make the phaco incision on the steep meridian of corneal astigmatism. If the patient … More

1563: phaco incision between RK cuts

Radial keratotomy (RK) makes cataract surgery far more challenging. The IOL power calculations are dramatically affected and during surgery we … More

1561: sudden chamber deepening

This patient has a dense cataract and I increased the phaco power in order to help break apart the nucleus. … More

1544: the first chop didn’t work, so…

Enough resident cases for now. If you’re a novice surgeon who has enjoyed learning from the resident cases, you can … More

1521: when the anterior capsule wrinkles…

Wrinkling of the anterior capsule during the performance of the capsulorhexis can be concerning because it indicates that zonular support … More

1520: focal traumatic cataract

At the pre-operative consultation for this patient, it was unclear if there was capsular damage associated with this focal opacity. … More

1519: tilt and chop is efficient and safe

This is a complete cataract case, shown start to finish, using the tilt and chop technique. This is like the … More