Four handed phaco! What?

This is a case where we knew ahead of time there would be issues. The patient is mid 50s in … More

Descemet’s Membrane Detachment

When we make a corneal incision for cataract surgery, we must be careful to avoid damaging the attachment of Descemet’s … More

Recovering from an anterior capsule rip

We have extensively covered the topic of white cataracts here on CataractCoach and we have an entire subcategory devoted to … More

Cataract Quiz: Zonular Dehiscence

Our guest surgeon is Dr Willie Kan from Malaysia and he presents a very tough case: a traumatic white cataract … More

Never make an incision like this!

This is a resident case where the incision has terrible construction. The primary mistake is gliding the keratome along the … More

management of a dropped nucleus

This is a rare complication that can happen to any patient so the surgeon must know how to effectively manage … More

Capsule Break with I/A and rescue

Our guest surgeon today is Dr Ahmed Al Habash who shows us the best technique of dealing with a posterior … More

Punctured Posterior Capsule Rescue

There are two types of ophthalmologists who do not ever have surgical complications: those who do not operate and those … More

Ruptured Posterior Capsule Recovery

This patient had uneventful cataract surgery in the first eye with placement of a toric trifocal IOL in the capsular … More

Complicated Radial Keratotomy Case

This is a tough case where the patient had prior 16-cut radial keratotomy for treatment of a high degree of … More

Fixing IOL-induced UGH Syndrome

UGH syndrome is the triad of uveitis, glaucoma, and hyphema which all can be induced as a complication from sulcus … More

Fixing a Dislocated IOL

This patient had cataract surgery done elsewhere and now seeks your help for a sub-optimal outcome in the one eye. … More

Cataract Quiz: Why did the trypan do this?

Cataract Quiz: Why did the trypan blue dye do this? Why is the staining so odd looking? Why is the … More

Bad Incisions lead to trouble

This anonymous resident starts the case with a poorly placed and poorly constructed incision. It ends up bleeding, allowing blood … More

Crucial lessons learned in residency

A complication during surgery can be a mistake or it can be a lesson. The difference between them is that … More

Cataract Quiz: how to rescue this case

This patient has an intumescent white cataract and we know that poses a risk of capsular run-out due to the … More

warning: phaco wound burn!

This is among the most important cataract surgery videos that you will see in your lifetime. Really. I have taught … More

Cataract Quiz: What happened here?

Our quiz features a video from Gustavo Hüning, MD, MBA from Brazil and it shows an unusual situation that happens … More

posterior chamber deepens with capsule break

When the posterior chamber deepens during cataract surgery, it is usually a sign that the posterior capsule has been ruptured. … More

recovering from Argentinian Flag Sign

We have explained in great detail the techniques that can help to prevent the dreaded Argentinian flag sign with intumescent … More

Cataract Quiz: Trapped Air Bubble

We have a great learning case from Dr. Xiaogang Wang from Taiyuan, China with a surgical challenge. This patient has … More

recovering from posterior capsule rupture

Every surgeon, no matter how experienced, will experience complications. The rate of complications such as posterior capsule rupture declines substantially … More

Equanimity under Duress

When Sir William Osler left the University of Pennsylvania’s Medical School (the first one in the USA, started in 1765) … More

Safety with Cannula Use – be careful!

Beginning surgeons do not always realize that the force created by using small 27g cannulas can be quite high. If … More

Cataract Quiz: Why did the capsule rip?

This resident surgeon recently experienced quite a surprise: when he injected viscoelastic at the beginning of the surgery, the anterior … More

Resident recovers from capsule break

In the course of learning cataract surgery, resident ophthalmologists will encounter complications such as this posterior capsule rupture. The key … More

Cataract Quiz: Use the can-opener now?

During capsulorhexis creation, this resident surgeon loses control of the anterior capsule edge and it runs all the way out … More

Draining a choroidal hemorrhage

We recently featured a video of a sudden choroidal hemorrhage which happened during implantation of an IOL. This is a … More

Pars plana anterior vitrectomy

The only ophthalmologists who have zero surgical complications are those who don’t operate and those who are not fully truthful. … More

Fixing severe capsular phimosis

In a small number of patients, capsular phimosis can happen after cataract surgery. This can lead to severe distortion of … More

Review: capsule attachments with femto-laser

This young patient (about 40 years old), developed a white cataract which has severely impaired vision in this eye for … More

Anterior Capsule Rips Uncontrollably

Quiz time: What do you do when the anterior capsule rips uncontrollably in a young patient who is scheduled to … More

From routine case to disaster in 1 second

When I first saw this video, which was submitted by an anonymous surgeon, I was in disbelief. I simply could … More

Tough cataract case for a resident

We are thankful for the many video submissions we receive from our readers, particularly from residents or registrars who are … More

Recovering from Argentinian Flag Sign

We have an entire section devoted to achieving success with white cataracts, including intumescent white cataracts. But even in expert … More

Staying calm when you see danger signs

The second that I see this round hole, I know that it is a danger sign. We have previously explained … More

Descemet Membrane Detachment

When we make a phaco incision that involves the cornea, there is always a risk of having focal detachment of … More

Cataract Quiz: What do you do now?

This is a complication that is sure to happen to every beginning cataract surgeon: a broken posterior capsule as a … More

Expulsive Choroidal Hemorrhage!

This video is a MUST SEE! An expulsive choroidal hemorrhage is a rare complication than any cataract surgeon must be … More

Cataract Quiz: Chopper breaks zonules

The resident surgeon has good hands and is talented, but like all new surgeons, he is lacking in experience. The … More

Posterior capsule rupture – finish the case

This resident case is a challenge: the posterior capsule is ruptured but there is still cortex to be removed. Can … More

Cataract Quiz: What’s your next move?

You are performing routine cataract surgery and then you suddenly notice that the posterior capsule is open and a nuclear … More

How to recover from a capsule rupture

It happens to all surgeons, and it is much more common in beginning surgeons: rupture of the posterior capsule during … More

Cataract Quiz: When did the bag break?

In this anonymously submitted resident video, there is a break in the posterior capsule during cataract surgery. With the assistance … More

Do not withdraw infusion with a capsule break

If there is a break in the posterior capsule, withdrawing the infusion will allow the anterior chamber pressure go to … More

Danger: Clear Crescent Red Reflex

When you are mobilizing a dense nucleus and you briefly see a bright, clear, crescent-shaped red reflex, you can be … More

Cataract Quiz: What happened here?

Look carefully at this picture: what do you see? There is a three-piece IOL in the sulcus and there is … More

Mentally Recovering from Complications

There are only two types of ophthalmologists who never, ever get surgical complications: (1) those who don’t operate, and (2) … More

Posterior Capsule Rupture! Now what?

In this anonymously submitted case from a resident surgeon in training, there are many great lessons to be learned. We … More

Cataract Quiz: Why did we get bleeding here?

In this resident case, the IOL is in the capsular bag, the capsulorhexis is intact, the viscoelastic has been removed … More

Recovering from a radialized capsulorhexis

Learning to perform a consistent capsulorhexis is one of the toughest steps of cataract surgery. The anterior capsule is only … More

Traumatic Cataract with Mydriasis: Part 2 Pupilloplasty

This patient suffered severe trauma as the result of an airbag injury from a car accident about one year ago. … More

Traumatic Cataract with Mydriasis: Part 1 cataract surgery

This patient suffered severe trauma as the result of an airbag injury from a car accident about one year ago. … More

Severe Capsular Phimosis

Capsular phimosis occurs when there is severe contraction of the anterior capsular tissue which results in a shrinking of the … More

Quiz: What will happen next? Look carefully

This picture tells me that there is going to be an issue during this case. As soon as the incision … More

Tear Out of the Anterior Capsule

In this video, which was anonymously submitted, an experienced surgeon encounters a routine cataract case where the anterior capsule is … More

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