This is a case where we knew ahead of time there would be issues. The patient is mid 50s in … More
Category: complications
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: Optic-Iris Capture
Happy New Year! It’s Quiz Time: how do you approach this case with optic-iris capture and a dense fibrotic membrane? … More
Cataract Quiz: What is the problem here?
Time for another Cataract Quiz. Look carefully at the photo — the IOL has just been implanted and now it … More
Cataract Quiz: Why is this cortex so adherent?
This seemed like a completely normal case… until it came time for removal of the last bit of cortex, which … 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 happening in this eye?
Look carefully at this photo taken at the slit-lamp microscope. What is happening in this eye? Describe what you see … 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
Quiz: What is going on with this IOL haptic?
The surgery has gone very smoothly and the senior resident is doing a great job. The incisions are good, the … 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
Capsular Tension Rings in Cataract Surgery
Capsular tension rings are flexible plastic loops which are designed to exert outward force at the capsular bag equator to … 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
Quiz: What is the Problem that you see here?
This video has been sent to us by an anonymous resident surgeon in training. During this case there was a … 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
Posterior Capsule Break with a Toric IOL in the bag
The posterior capsule sustained a break during phaco which was near the capsular bag equator and not immediately noticeable to … 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
Quiz: What is the problem here? Look Carefully!
This case seemed like a routine cataract surgery. Everything went smoothly. A good incision, a nice round capsulorhexis, easy removal … 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
The IOL is stuck in the incision! What should we do?
This valuable teaching video was submitted by an anonymous resident who is still in training. In this surgery, a smaller … 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
Misloaded IOL rips open the posterior capsule
An anonymous surgeon submitted a video of a complication that happened with a misloaded IOL injector. We are thankful for … 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
Twist Technique to Easily Explant the IOL
There are times when we need to explant an IOL from the eye. This can be at the time of … 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
Important Lesson from a Misloaded IOL
I had a case recently, where the surgical assistant told me that he was having difficulty loading the IOL into … 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
Why did the IOL Haptic get stuck to the Optic?
We use thin IOLs which are then placed into injectors which roll, fold, or compress the them so that … 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
How to deal with a Mis-loaded IOL
There are occasions when we will be handed an IOL which has been loaded incorrectly into the injector system. It … 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
Cataract Surgery with Traumatic Zonular Loss
Are you ready for a challenge? This patient is a relatively young construction worker who sustained a blunt traumatic ocular … 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