2030: centered capsulorhexis uneven dilation

Even if the pupil dilation is asymmetric, the capsulorhexis should be centered. This can be tricky if your normal routine … More

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

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