Even if the pupil dilation is asymmetric, the capsulorhexis should be centered. This can be tricky if your normal routine … More
Category: complete cases
2003: fix synechiae with a pale blue iris
In my private practice many patients have light colored irides with scant pigmentation. The iris stroma tends to be very … More
1996: negative spherical aberration IOLs
I have a great educational video about spherical aberration and IOLs that is coming out in the next few weeks. … More
1988: radial keratotomy with lasso sutures
16 cut radial keratotomy with 2 lasso sutures
1953: soft posterior polar young patient
Studies have shown that 1 out of 3 posterior polar cataract surgeries result in a ruptured posterior capsule. Here’s the … More
1925: pupil stretching is safe, easy, effective
Performing pupil stretching is safe, easy, and effective but there is a delicate balance. Too forceful of a stretch can … More
1913: favorite technique for post PPV eyes
Prior pars plana vitrectomy (PPV) makes the cataract surgery more challenging because it removes the anterior hyaloid face and vitreous … More
1912: Refractive Lens Exchange High Myopia
We can agree that a refractive lens exchange is a good way to address high hyperopia in presbyopic patients, but … More
1907: asteroid hyalosis & cataract surgery
Asteroid Hyalosis is seen in about 1-2% of your cataract surgery patients and it is most often unilateral. These focal … More
1862: nanophthalmic eye cataract surgery
Experienced cataract surgeons know that the most challenging cataract cases are often the nanophthalmic eyes. These tiny eyes have a … More
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
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