Quiz: what is different about this white cataract?

This patient has an intumescent white cataract but something is different about this case. In fact, there is a very … More

Quiz: iris is prolapse & bleeding – now what?

Quiz time: This patient has floppy iris syndrome from tamsulosin use and you are experiencing iris prolapse during his cataract … More

Secrets to Avoid Corneal Edema after Cataract Surgery

Corneal edema can occur after cataract surgery due to a number of factors such as a higher degree of ultrasonic … More

How to Save this Run-Out Capsulorhexis

This case is performed by a junior resident who has done about 20 cases so far. The trouble starts when … More

Slow motion analysis of posterior capsule rupture

Watching surgical video of cases is very helpful to understand the how and when of the complications of cataract surgery. … More

Where did the hemi-nucleus go?

This video was submitted by Dr Ravi Prasad Challa from India and it showcases a very rare complication: a break … More

Pars Plana Anterior Vitrectomy can be very helpful

When the capsule breaks during cataract surgery and the vitreous prolapses into the anterior segment, it is important to clear … More

Review: Be Careful if you see the Hole Punch Sign

In your first 1000 cataract surgeries, the most common cause of a posterior capsule rupture is iatrogenic damage from the … More

Retained Cortex leads to trouble and macular edema

In this anonymously-submitted case, a small amount of lens cortex was left in the capsular bag at the time of … More

Review: Anterior Vitrectomy & Sulcus IOL Placement

With vitreous prolapsed into the anterior chamber, we must perform a vitrectomy before placing the IOL in the eye. In … More

Quiz: Which eye do you fix first?

This patient needs surgery on both eyes. The right eye has a cataract which is limiting the vision to 20/80 … More

Dense Morgagnian Cataract with Capsule Break

With a Morgagnian cataract, the entire cortex becomes liquified and then the remaining lens nucleus floats within this fluid. In … More

Anterior Vitrectomy & Sulcus IOL with Optic Capture

With vitreous prolapsed into the anterior chamber, we must perform a vitrectomy before placing the IOL in the eye. In … More

Collapse of the capsular bag during cortex removal

This is a continuation of the case from yesterday, you can review it here. In that case, the phaco probe … More

The Chop failed because the nuclear halves did not separate

The phaco chop technique is like splitting firewood: the instrument creates the initial cleavage plane which then must be propagated … More

Guest Surgeon: Recover from the Argentinian Flag Sign

In our many videos about white cataracts (full series can be found here), we know that one of the biggest … More

Rescue this White Cataract Capsulorhexis

Our CataractCoach.com readers understand the challenges of white cataracts and in particular, intumescent white cataracts. With a capsular bag that … More

Review: Give the First Surgeon the Benefit of the Doubt

Sometimes you will examine a patient who had surgery elsewhere and you can tell that there were challenges and complications. … More

Review: Complete this case without vitreous prolapse

This is a great learning case from one of our young surgeons in training. The video is 14 minutes long … More

Quiz: What is this dark spot and what is the danger?

This is a complicated case sent to us for review by an anonymous surgeon. You can also submit a video … More

Pars Plana Anterior Vitrectomy & IOL Retrieval

While most cases of vitreous prolapse during a complicated cataract surgery can be effectively address via limbal incisions, there are … More

Be Careful if you see the Hole Punch Sign during Phaco

In your first 1000 cataract surgeries, the most common cause of a posterior capsule rupture is iatrogenic damage from the … More

Converting from Phaco to Manual ECCE Surgery

While it is rare, there are times when it is important to convert from a phaco approach to a manual … More

Bleeding in the Anterior Chamber during surgery

It is unusual to encounter bleeding in the anterior chamber during cataract surgery, but rarely it does happen. The typical … More

Quiz: Can you spot the potential complication?

In this case, everything seemed routine and it progressed quite smoothly. A nice incision, an accurate capsulorhexis, efficient nucleus removal, … More

White Cataract Posterior Capsule Rupture!

In this anonymous video from a surgeon in training, we have quite the challenge: a dense white cataract surgery where … More

Never make your phaco incision like this!

In this anonymous video we have a phaco incision that is very poorly made. The placement is too far from … More

Suture Complications after Cataract Surgery

Depending on the size and architecture of our incisions for cataract surgery, sutures may be required to ensure adequate closure … More

How to fix Iris Prolapse in Cataract Surgery

In this resident performed surgery, we encounter iris prolapse after too much hydro-dissection. This results in the iris prolapsing out … More

Ruptured Capsule Rescue & Anterior Vitrectomy

Very important learning case of a posterior capsule ruptured then a rescue including anterior vitrectomy.

Focal lens opacity after intra-vitreal injection

This patient had multiple prior intra-vitreal injections for macular disease and now presents to you for cataract surgery. Upon examination … More

Failure to Pivot in the Incision causes Issues

One of the most common mistakes made by novice surgeons is the failure to pivot in the incision. This causes … More

The posterior capsule is wide open – now what?

This is a great learning case from one of our young surgeons in training. The video is 14 minutes long … More

Pupil Ring placed in one movement, but there is a catch…

I wanted to try a new technique: placing all 4 scrolls of the Malyugin ring on the iris in one … More

Descemet Detachment at the Phaco Incision

When we construct our corneal phaco incisions, we must be careful to give them the proper architecture and form. We … More

Why is the pupil peaked during this cataract surgery?

The iris is a fluid tissue that moves within the eye in response to the fluidic changes of cataract surgery. … More

Critical Lesson: Giving the Benefit of the Doubt

Sometimes you will examine a patient who had surgery elsewhere and you can tell that there were challenges and complications. … More

Should you try to rescue a dropped nucleus?

For most situations, I recommend that if the cataract nucleus drops into the vitreous cavity due to a ruptured posterior … More

Wait! Is the Posterior Capsule Ruptured?

In this video which was submitted anonymously, the guest surgeon had a routine case with an intact capsulorhexis. But then … More

Little Technique to Rescue a Runout Capsulorhexis

The first time that I saw Brian Little, FRCS, FRCOphth demonstrate the technique for rescuing a runout capsulorhexis, I was … More

When to Revert to a Can-Opener Capsulotomy

We have learned from the past two days of videos, that it is sometimes wise to revert to a can-opener … More

Complications from a Failed Capsulorhexis

There is a great deal of learning from this video where a failed capsulorhexis leads to a host of issues … More

Poor Draping leads to more Complications

This case should be a routine, straightforward surgery with a low chance of complications. But that changes when the draping … More

Treating Iris Bleeding during Cataract Surgery

Typically, modern day phacoemsulification cataract surgery is relatively bloodless because we are making incisions in the cornea and then operating … More

Hidden Nuclear Fragment during Cataract Surgery

When we break up the cataract during phaco surgery, we create many small little pieces which are then aspirated from … More

Fixing a Radialized Capsulorhexis in manual ECCE

When I first started teaching residents about 20 years ago, we would have the residents do about 10 surgeries of … More

Dealing with Conjunctival Chemosis

We have covered the topic of the rules for an ideal phaco incision and one of them is to barely … More

Managing Mild Iris Prolapse during Phaco

The iris can prolapse any time that a pressure gradient exists in front of, and behind the iris tissue. This … More

Lost Capsulorhexis – here is the Solution

This patient is having cataract surgery but during capsulorhexis creation, the flap edge seems to get lost. And due to … More

Posterior Capsule Rupture & Anterior Vitrectomy

Early in the learning curve of cataract surgery, beginning surgeons end up with a posterior capsule rupture about 5% of … More

Preventing and Treating Capsular Phimosis

The capsular bag contracts when we remove the thick cataract (4+ mm thick) and replace it with a thin IOL … More

Rescuing the Radialized Capsulorhexis

The capsulorhexis is an important early step of cataract surgery because it gives strength to the capsular opening so that … More

Quiz: Persistent Corneal Edema – Why?

This 70 year old patient had successful cataract surgery about one month ago. There were no complications. The patient has … More

Why did we get a Phaco Wound Burn?

The cornea is a very delicate tissue: it’s thin, clear, avascular, and susceptible to damage, particularly from the heat that … More

Recovering from a Hole in the Posterior Capsule

The posterior capsule is very thin (usually about 4μm) and very delicate and in the course of cataract surgery, it … More

A Sudden Sneeze or Cough during Cataract Surgery

Patients often ask us, “What happens if I have to sneeze or cough during cataract surgery?” And it’s a valid … More

The Curse of the Baby Rhexis

This case is brought to you in conjunction with EyeGuru.org, an excellent resource for both ophthalmologists in training and ophthalmologists … More

3 critical differences in Cataract Surgery for patients over Age 90

Average life expectancy is at an all-time high in the US at 79, with even better news for … More

The Informed Consent Process for Cataract Surgery

As ophthalmologists, we know the most about cataracts and the potential benefit to our patients of any planned cataract … More

If you see VMT on OCT, do not do cataract surgery!

When we do cataract surgery, we remove a relatively thick human, crystalline lens and we replace it with a … More

20% of Cataract Patients have an Epi-Retinal Membrane

We must critically evaluate the retina before cataract surgery. When our cataract patients report a decline in vision it is … More

4 times when you should NOT do surgery

Any surgeon can operate, but it takes a surgeon with good judgment to know when not to operate. During my … More

3 Keys to doing 4-point Sceral-sutured IOLs

From CataractCoach.com: With video footage provided by Dr. Michael Patterson, we review the anterior segment approach to 4-point fixation of an IOL … More

Surgical Approach to the Dislocated IOL

(scroll down for full video of four-point fixation of an IOL to the sclera) Cataract surgery has an amazing success … More

Why did this IOL de-center?

This patient had cataract surgery about 2 months ago with a local ophthalmologist. She did well initially, achieving 20/20 vision … More

Recovering and learning from your surgical complications

Everyone eventually falls off the horse and has a complication. The key is to recover and learn from it, be … More

White Cataract: Run-Away Capsulorhexis. Help!

If you’ve done surgery on a patient with a white cataract, you’ve probably experienced the dreaded Argentinian Flag Sign. (Full … More

When the nucleus drops during Cataract Surgery

Every cataract surgeon knows that while complications are rare, if you do a significant volume of surgery, then you’ll certainly … More