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

1508: your last surgery before graduation

After so many years of education and training, you are almost done with your residency / fellowship training. In the … More

1501: complete toric IOL technique

Toric IOLs are great options to address corneal astigmatism, especially when it is 1 diopter or greater in magnitude. This … More

1485: how I know zonular support is weak

Weak zonular support makes cataract surgery far more challenging and increases the potential risks such as vitreous prolapse, retained lens … More

1454: peeling off the pupillary membrane

This patient has a long history of prior uveitis / anterior iritis which caused synechiae where the iris became adherent … More

1453: Quiz: What is your next step?

This is a tough case where the nucleus is very dense and difficult to chop, but the bigger challenge is … More

1451: Quiz: Where is the lens fragment?

A retained lens fragment is common in cataract surgery because we are breaking up the cataract into many smaller pieces … More

1450: pseudo-exfoliation in a 90 year old

Pseudo-exfoliation syndrome means that cataract surgery will be more challenging. The pupil will not dilate as much, the zonular support … More

1449: monocular patient with 16 cut RK

This is a tough case in a patient with just one eye. He had a prior history of 16-cut radial … More

1446: taking pride in your routine surgery

Routine surgery is probably 90% of what you perform every week in your operating room (or operating theatre), but sometimes … More

1445: rubbery brunescent cataract

There is a pleasure in helping patients with a dense brunescent cataract: we enjoy the surgical challenge and the patient … More

1444: the patient moved during the rhexis

As I am performing the capsulorhexis, the patient unexpectedly moved and there is a run-out of the capsule tear. The … More

1443: the nucleus just will not rotate

This is a seemingly routine case, shown start to finish, where I find it challenging to rotate the nucleus despite … More

1442: this nucleus is denser than it looks

This is a complete cataract case, shown start to finish, of a patient seen in my private clinic. At the … More

1425: posterior polar or sub-capsular?

Time for you to make the call: you bring the surgical microscope to the eye and just before you start … More