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

Quiz: A shallowing capsular bag during cortex removal

The irrigation / aspiration probe is placed in the eye and we begin cortex removal. But as we try to … More

Quiz: Why won’t this nucleus rotate?

This patient has a relatively opaque cataract with a pre-operative vision of only counting fingers. When we go to perform … More

Quiz: Why does the red reflex change during surgery?

This is a routine cataract surgery, but there is a limited red reflex during the surgery. This is sometimes due … 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

Opaque Cortical Cataract Cases can be Challenging

The cortical cataract changes look like spokes of a wheel and they can cause issues for both the patient and … More

How to Flip Up the Epi-Nucleus for easy removal

Hydro-delineation can be helpful to separate the dense endo-nucleus from the epi-nucleus of the cataract. This makes is a bit … More

Various Approaches to removing the Epi-Nucleus

When we perform hydro-delineation, we separate the dense endo-nucleus from the relatively soft epi-nucleus. This is helpful in multiple different … More

Be Cautious with the Wrinkly Old Bag

This is one wrinkly old bag! Of course, we are referring to the capsular bag in this cataract surgery. This … More

Understanding Reflux Mode during Phaco

Reflux mode is when you use the foot-pedal to reverse the fluidic pump of your phaco machine. Instead of aspirating … More