Polishing the capsule and then it splits! Now what? It’s the moment every surgeon dreads: you’re polishing the posterior capsule … More
Category: cortex
2775: cortical pre-aspiration before phaco
Cortical pre-aspiration prior to phacoemulsification is a useful strategy for reducing lens mobility and improving surgical control before nucleus removal. … More
2751: cleaning the bag and then it splits open
A highly experienced surgeon is more likely to experience a rupture of the posterior capsule during cortex removal rather than … More
2730: left behind cortex will swell up!
It’s tempting when you’re a beginning surgeon to just leave some residual cortex in the capsular bag but then the … More
2723: light pipe illumination to clean the bag
In cataract surgery, optimal visualization of the posterior capsule is crucial for safe and effective polishing. The light pipe, traditionally … More
2571: zonular loss noted in cortex removal
In this resident case, you can clearly see zonular loss during cortex removal but you could have also seen it … More
2502: removing cortex before the nucleus
Sometimes you need to think differently in order to innovate. In essentially every cataract surgery that I have performed, I … More
2431: Quiz: What’s different with cortex?
Happy New Year to all of the CataractCoach fans — thank you for a great 2024 and we are looking … More
2215: cortex removal without IA probe
Our guest surgeon is highly experienced and he does something that I’ve seen other Brazilian surgeons do: avoid using the … More
2116: cortical cleaving hydro-dissection
Cortical cleaving hydro-dissection was described 30 years ago by Howard Fine MD, a pioneer in the shift to modern day … More
2020: removing calcified lens cortex
This is a very difficult cataract case: the anterior capsule is fibrotic and wrinkled and there is calcified cortex that … More
1937: posterior capsule hydro-polish
Sometimes patients with posterior sub-capsular (PSC) cataracts can have adherent lens opacities stuck on the center of the capsule. This … 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
1721: Curriculum Lesson 15: Cortex
The next lesson in our CataractCoach Curriculum series is lesson 15 where we focus on lens cortex removal. This seemingly … More
1578: how to rescue this capsule split
You are performing cataract surgery and everything appears routine as the case is progressing smoothly. The nucleus is removed and … More
1486: LIDRS to help with cortex removal
LIDRS is Lens-Iris Diaphragm Retropulsion Syndrome and it occurs where there is a reverse pupillary block and the pressure in … More
1455: cortex removal before nucleus removal
This video shows something that I have never previously seen before: removal of the lens cortex prior to removing three … More
1409: vitreous prolapse into the AC
An anonymous surgeon submitted this video and I knew that I had to share it with our fans. Every surgeon … More
1390: CTR insertion with cortex in bag
It is easiest to insert the capsular tension ring (CTR) when the capsular bag is completely empty of lens material. … More
1358: sub-incisional cortex removal
In the USA, the most common method for removal of cortex is using a coaxial IA probe, whereas in other … More
1273: that’s not cortex being aspirated…
This is a good learning case, and I am thankful to Dr Amar Kulkarni for submitting it. We see zonular … More
1261: Why is the AC so shallow in IA?
Remember that we are operating in a very tiny space of less than 1 milliliter of volume and that we … More
1106: thick cortex / epi-nucleus remains
In cases with insufficient hydro-dissection, we can be left with a thick cortex and epi-nuclear shell after performing hydro-delineation. How … More
1072: epi-nucleus removal technique
In cases where we perform hydro-delineation and we have a separate epi-nuclear shell to remove, what is the best technique. … More
1070: Posterior Polar Cortical Cleaving
I really enjoy watching surgical videos from Dr. Neto Rosatelli from Ribeirão Preto, Brazil because he mixes his high degree … More
1053: that’s not cortex you’re pulling!
In this anonymously submitted video, we see that if the capsule is inadvertently grabbed by the suction from the I/A … More
Guest surgeon: Milky White Cataract
Our guest surgeon today is Dr Pooja Bhomaj from Miraj, India and she presents a case of a milky white … More
Rock the Nucleus in White Cataracts
The topic of white cataracts is so popular here on CataractCoach that we have an entire category devoted to it … More
Finishing this case will be difficult
The reason why ophthalmologists need to perform at least 1,000 cataract surgeries until they are sufficiently up the learning curve, … More
Keep track of cortex during surgery
Even with good dilation, cortex can be hidden at the capsular bag equator. In this case, the dilation is about … More
easily aspirating the epi-nucleus
It is much faster and easier to aspirate the epi-nucleus using the phaco probe than the I/A probe because the … More
cannula for cortex aspiration
Bimanual irrigation/aspiration for cortex removal has an advantage: it is easy to switch hands and then access a full 360 … More
traumatic cataract with bulging capsule
This 23 year old patient was involved in an accident and developed bilateral traumatic cataracts. When we examine the patient … More
Review: if the bag shallows during cortex removal
The irrigation / aspiration probe is placed in the eye and we begin cortex removal. But as we try to … More
Complete Case: Cortical Cataract
With a cortical cataract, patients are very symptomatic, particularly if the cortical opacities are within the visual axis. These tend … 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
Complete Case: Soft Cortical Cataract
Another addition to our series on Complete Cataract Cases is this technique for soft cortical cataracts. These cataracts are typically … 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
Epi-Nucleus Flip Technique
With a thick epi-nuclear shell, it is easier to remove it with the phaco probe as compared to the I/A … More
Cortical Cataracts can cause “white-out”
Cortical cataracts occur when some of the lens material becomes liquefied, thereby blocking the visual axis. When we perform hydro-dissection … More
Always check under the Iris
We have covered this lesson before, but it certainly is worth repeating: always check under the iris when you perform … More
Methods of Capsule Polishing
For polishing of the undersurface of the anterior capsular rim, we can use a friction method with specialized instruments or … More
Review: Check under the iris for lens material
When performing cataract surgery for an eye with a moderate or small pupil, be sure to check under the iris … More
I/A probe going under the cortex
Most of the time, we grab the cortex edge under the anterior capsular rim and then we strip centrally. But … More
Does Capsule Polishing prevent capsular opacity?
There has been much debate around the issue of polishing of the undersurface of the anterior capsular rim, yet there … More
Linear marks seen during cortex removal
For surgeons with just a few years of experience, the part of cataract surgery where a posterior capsule break is … 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
Checking under the Iris for Hidden Cortex
In cases where the pupil does not dilate fully, it can be difficult to see the entire capsular bag to … More
Quiz: What happens with insufficient hydro-dissection?
What happens if the hydro-dissection is insufficient during cataract surgery? The cortex and epi-nuclear shell remain very adherent to the … More
Flip up the epi-nucleus for easy aspiration
In some cataract cases it is helpful to perform hydro-delineation to separate the dense endo-nucleus from the softer epi-nucleus. Once … More