2987: MSICS: split the nucleus prior to removal In manual small incision cataract surgery, splitting the lens nucleus in half … More
Category: dense cataract
2949 opaque cornea with a surprise inside
2949: Opaque cornea with a surprise inside Operating on an eye with an opaque cornea is challenging enough, but sometimes … More
2937: peeling a posterior capsule plaque
Peeling a posterior capsule plaque is a high-stakes maneuver that requires a delicate touch and steady nerves. These plaques are … More
2928: flip nucleus to break fibrous plate
Managing a dense brunescent cataract requires a strategic shift in orientation when traditional chopping fails to penetrate the leathery posterior … More
2895: sculpting grooves in a dense nucleus
The Escaf Punta Hibrida phaco tip is specifically designed to handle the challenges of ultra-dense, rock-hard nuclei. Its unique hybrid … More
2892: The dense “Coca-Cola” Cataract
The Challenge of the Dense, Brunescent “Coca-Cola” Cataract When a cataract is described as a “Coca-Cola” type, it often refers … More
2837: vertical chop in dense white cataracts
In dense white cataracts, the vertical chop technique is highly effective because it utilizes shearing forces rather than the compressive … More
2832: capsular bag full of rocks!
This case features a dense white cataract where intra-lenticular stone formation happens resulting in small, dense rocks in side the … More
2759: brunescent cataract cross chop
The cross-chop pre-chop technique is particularly advantageous when managing a dense brunescent cataract, where conventional divide-and-conquer or single-plane chopping may … More
2654: dense white cataract with a surprise
Approaching cataract surgery in a dense white cataract with a fibrotic anterior capsule presents significant challenges that require careful planning … More
2615: dense white cataract with femto laser
Our guest surgeon uses a femtosecond laser to help with cataract surgery on a dense white cataract. The question is … More
2545: dense cataract MSICS with a surprise
Our guest surgeon does a great job with this very difficult cataract surgery. This very elderly patient has a very … More
2509: Morgagnian cataract technique
A Morgagnian cataract is a type of hypermature cataract where the lens cortex has fully liquefied, causing the dense nucleus … More
2481: dense cataract horizontal chop
Our guest surgeon does a great job with this dense whitish cataract using the horizontal chop technique. These cases can … More
2293: Case 350 with a dense cataract
A dense cataract is more challenging because of the difficulty in breaking it into smaller pieces (nucleo-fractis) and the increased … More
2202: brunescent cataract phaco
Our guest surgeon does a great job of phaco with this truly dense, brunescent cataract. This video includes the pre-op … More
2094: dense white cataract phaco chop
In yesterday’s video (video 2093) we featured the MSICS procedure for a dense white cataract. And today we feature a … More
2093: MSICS for a dense white cataract
In the USA, most residency programs do not teach MSICS. Perhaps you may get a little experience with older style … More
2058: cracking the leathery posterior plate
With a dense, brunescent cataract the posterior aspect of the nucleus becomes tough and leathery. Traditional chopping methods usually are … More
2055: uveitic cataract and pupil membrane
This patient has a long-standing history of prior uveitis which has caused a fibrotic membrane to develop over the pupil. … More
1968: dense cataract phaco without ultrasound
Looking at the photo above, it would seem incredulous that it could be removed with a phaco probe with zero … More
1879: small pupil, synechiae, dense cataract
These types of cases where there is a small pupil due to posterior synechiae can be challenging. We must first … More
1858: MSICS dense brunescent cataract
With a dense brunescent cataract, the beauty of MSICS is that no ultrasonic energy is needed to break apart the … More
1850: ASCRS 2023 Course Case 9
On Sunday, May 7, 2023 we had our Best of CataractCoach.com course at the ASCRS meeting in San Diego. It … More
1845: ASCRS 2023 Course Case 5
On Sunday, May 7, 2023 we had our Best of CataractCoach.com course at the ASCRS meeting in San Diego. It … More
1835: efficient phaco chop dense nucleus
This patient has a dense cataract — the kind where the posterior plate of the nucleus is tough and fibrous … More
1833: Curriculum lesson 23: dense cataracts
The next lesson in our 25 part curriculum series is focused on dealing with dense cataracts. You can see the … More
1822: lens snare/loop splits the bag!
The idea of a lens snare or loop to mechanically split the nucleus is decades old and we previously discussed … More
1801: continual injection of viscoelastic
We use viscoelastic (also called OVD = ophthalmic visco-surgical device) during cataract surgery to protect the delicate intra-ocular structures, in … More
1768: brunescent dense rock cataract
This is a tough case and when you see the microscope lights turned up but still no red reflex, you … More
1732: this white cataract is quite dense
We have previously explained that not all white cataracts are the same and that there is an entire spectrum of … More
1686: dense cataract iris & zonular loss
This case is beyond 10 out of 10 in difficulty and our guest surgeon, Dr Steve Safran, is a true … More
1656: a really tough case for a resident
For any cataract surgeon this is a tough case: 94 year old patient (nonagenarian), short axial length, shallow anterior chamber, … More
1645: phacolytic glaucoma & synechiae
Our guest surgeon does a great job with a very difficult cataract surgery. The patient has phacolytic glaucoma where the … More
1611: dense cataract with foot pedal video
Surgeons who want to learn phaco chop sometimes have a challenge with the foot pedal control. When should energy be … More
1580: phaco surgeon does great MSICS
Our guest surgeon is a very experienced cataract surgeon and an expert at phaco, but he has decided to perform … More
1571: dense brunescent whitish cataract
I recently did LASIK surgery for a young patient, in his early 20s, who surprised me when he said that … More
1557: small pupil and dense cataract
This is a fun video where I give the commentary while watching it for the first time. The case is … More
1528: open globe, failed graft, & cataract
This video is a series of three separate surgeries on the same patient, by the same surgeon, Dr Jimmy Hu … More
1516: ultra dense black cataract
Our guest surgeon is an amazing surgeon, Dr Neto Rosatelli from Brazil. He presents a very, very dense cataract in … More
1515: expert management of DWC
DWC stands for dense white cataract and in this case, that is exactly what we have. In addition, the anterior … More
1514: “the toughest case of my life”
“The toughest case of my life” is quite a statement when it is said by a highly experienced, expert level … More
1487: dense central endo-nucleus
In this case, there was a dense central endo-nucleus that seemed somewhat resistant to chopping. When I chopped the nucleus, … More
1476: ASCRS case 7: dense cataract tricks
Another great case from the 2022 ASCRS CataractCoach instructional course, this time focusing on dense cataracts. There are some good … More
1453: Quiz: What is your next step?
This is a tough case where the nucleus is very dense and difficult to chop, but the bigger challenge is … More
1445: rubbery brunescent cataract
There is a pleasure in helping patients with a dense brunescent cataract: we enjoy the surgical challenge and the patient … More
1442: this nucleus is denser than it looks
This is a complete cataract case, shown start to finish, of a patient seen in my private clinic. At the … More
1441: converting from phaco to MSICS
Our guest surgeon is Jack Shao MD who is a faculty member at the Cole Eye Institute at the Cleveland … More
1382: hyper mature cataract MSICS
In an eye with a truly dense, hyper-mature cataract, MSICS (manual small incision cataract surgery) can be a better option … More
1301: dense cataract divide and conquer
The divide and conquer technique is a tried and true method for nucleo-fractis. It works well in a variety of … More