As surgeons, we love it when we can make an incredible improvement in the lives of our patients. An added … More
Category: complete cases
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
1619: high power IOLs for radial keratotomy
Over the course of decades, we have found that radial keratotomy (RK) keeps flattening the cornea. Initially these previously myopic … 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
1522: pupil size affects EDOF IOL vision
As surgeons, we know that the refractive outcome for each patient depends on our surgical technique, the calculations, the technology, … 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