This is the maximum pharmacologic dilation of about 4mm and the patient is noted to be taking tamsulosin (Flomax) for … More
Category: flomax IFIS
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
Misloaded IOL in a Floppy Iris Cataract Case
Even the best surgical technicians can have a case where the IOL is misloaded into the injector. It is up … 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