This sign means I need a pupil ring

this sign means that I need a pupil ring for cataract surgery

You don’t always need rings or iris hooks

For a case like this, there is no need for a pupil expansion ring or iris hooks. These devices can … More

Complete Cataract Case: No pupil ring!

Another video in our series of complete cataract cases, where the entire surgery from start to finish is presented. There … More

lift the iris in smaller pupil cases

While we think that an 8 mm pupil is very well dilated, we must remember that the capsular bag has … More

complete cataract case: great red reflex

We all love a great red reflex during cataract surgery because it makes is much easier to see details such … More

Surgeon returns after a 3 month hiatus

Performing surgery at a high level is a skill that must be continually honed and practiced. What happens when we … More

Resident Cataract Case with Iris Hooks

For a small pupil case, using iris hooks is helpful to give better access during cataract surgery. This case is … More

Review: Management of Iris Prolapse

In this resident performed surgery, we encounter iris prolapse after too much hydro-dissection. This results in the iris prolapsing out … More

Small pupil, PXF, and IFIS

For a beginning surgeon it is helpful to see surgeons performing techniques that are out of your comfort zone. The … More

Quiz: Should I have used a pupil ring?

This is a tough case and the pupil is smaller than I expected. Should I have used a pupil expansion … More

Complete Case: Floppy Iris & Loose Zonules

There is a benefit to watching a video of a complete cataract case, from start to finish. This is particularly … More

Complete Case: Flomax & Toric IOL

Many of our CataractCoach.com readers have been asking for complete cases, shown from start to finish. There is a lot … More

Fix this Iris Prolapse in 2 seconds

Really. This is not an exaggeration. If you understand the physics of why the iris is prolapsing through the incision, … 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

Phaco Chop in the bag with smaller pupils

In many of the prior videos related to smaller pupils, I have emphasized the technique of bringing the nucleus partially … More

Easy way to fix iris prolapse

We have all experienced it: the case is going well but then the iris starts to prolapse out of the … 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

Learn the Pupil Stretch Technique

Stretching the pupil during cataract surgery is a safe and effective way to improve access via mechanical dilation. While there … More

Quiz: For a pupil like this, what is your approach?

With time, young ophthalmologists develop surgical judgment and they are able to look at a case and decide what approach … More

Quiz: How to fix iris prolapse at the incision

The iris is a kinetic and flowing structure that moves during pupil constriction and dilation. But the iris can also … More

Synechiae & Small Pupil solved with the B-Hex ring

This video features guest surgeon Neto Rosatelli MD from Brazil showing us his approach to cataract surgery in a uveitic … 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

Avoiding Iris Prolapse & Damage in Blue Eyes

We always want to perform a minimally invasive and minimally traumatic cataract surgery. We want to be safe, efficient, and … More

Higher Infusion Pressure Helps in Floppy Iris Cases

In our phaco fundamentals series, we have explained the basics of choosing fluidic parameters for the phaco machines. These settings … More

Malyugin Ring for Pupil Expansion in Cataract Surgery

A well-dilated pupil facilitates cataract surgery and if the patient has a small pupil there are multiple options for safely … More

Sometimes Even Experts Struggle during Surgery

As we gain more experience and hone our surgical skills, we achieve the state of flow where the procedure progresses … More

Resident Case: Iris Prolapse during Cataract Surgery

When we encounter iris prolapse in a patient with a light-colored iris, we must be very careful because any iatrogenic … More

The iris/pupil can hold the nucleus during phaco

Today we have an unedited video of a routine case in a patient with floppy iris syndrome due to Flomax … More

Ovoid Pupils in Cataract Surgery – What Happened?

What is happening in these cataract surgery patients with prior Flomax (tamsulosin) use? Why are the pupils ovoid in shape? … More

Ruptured Capsule Rescue & Anterior Vitrectomy

Very important learning case of a posterior capsule ruptured then a rescue including anterior vitrectomy.

Cataract Surgery in Pigment Dispersion Syndrome

Cataract surgery in patients with Pigment Dispersion Syndrome can be challenging due to the anatomic changes which have happened over … 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

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

Moderate Floppy Iris Syndrome: Avoiding Prolapse

This patient took Flomax (tamsulosin) a few years ago for a brief period of time. He later stopped the medication … More

Phaco Flip in Post-Vitrectomy and Flomax Cases

Phaco flip has an advantage over other methods of nucleus division: the cataract is already partially out of the capsular … More

Resident IFIS / Iris Prolapse Cataract Case

Intra-Operative Floppy Iris Syndrome (IFIS) occurs primarily with the use of systemic tamsulosin (Flomax), a medication that aids in urinary … More

Small Pupil Flomax Adventures (without a ring!)

This is a really fun cataract surgery. After tens of thousands of cases, an unusual or challenging clinical situation really makes … More

Pupil Stretch using Capsulorhexis Forceps

To stretch a small pupil, you actually don’t need special instruments. Using two instruments such as choppers, hooks, or manipulators, … More

Avoiding Iris Prolapse when Sealing the Incision

When doing cataract surgery in patients with floppy iris syndrome, the iris has a tendency to prolapse via the phaco … More

Tips & Tricks for Using Pupil Expansion Devices

While I don’t use them often, pupil expansion devices such as the Malyugin ring, are useful when performing cataract surgery … 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

Bimanual Irrigation / Aspiration for Cortex

For most cases a coaxial arrangement of both the phaco and irrigation / aspiration (I/A) handpieces works very well. However, … More

Floppy Iris Syndrome with Phaco Chop

We have a fun case here: the patient has a long-time history of Flomax (tamsulosin) use which limits his pupil … 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

Expansion Ring for Small Pupil Cataract Surgery

For small pupil cases, I prefer to do stretching in order to expand the pupil and then I can proceed … More

Phaco Chop with Floppy Iris Syndrome

Many of our male patients take medications to help with urinary flow such as alpha-1 antagonists, the most common of … More

Bleeding from Pupil Expander! Now What?

Pupil expansion devices can be helpful to provide sufficient dilation in cataract surgery. This video features guest surgeon Ravi D. Goel, … More

3 tricks for Small Pupil + Flomax Cataract Surgery without Expanders or Iris Hooks

Can you do cataract surgery in an eye with a small pupil without having to use expanders or iris … More