When we make a corneal incision for cataract surgery, we must be careful to avoid damaging the attachment of Descemet’s … More
Category: incisions
Never make an incision like this!
This is a resident case where the incision has terrible construction. The primary mistake is gliding the keratome along the … More
Double Phaco Incisions to fix Astigmatism
double phaco incisions for treatment of astigmatism
Complicated Radial Keratotomy Case
This is a tough case where the patient had prior 16-cut radial keratotomy for treatment of a high degree of … More
Playlist: Phaco Incisions
The phaco incision is a critical part of the cataract surgery. A great incision is the mark of an accomplished … More
Bad Incisions lead to trouble
This anonymous resident starts the case with a poorly placed and poorly constructed incision. It ends up bleeding, allowing blood … More
warning: phaco wound burn!
This is among the most important cataract surgery videos that you will see in your lifetime. Really. I have taught … More
Incisional Techniques for Astigmatism
Cataract surgery can be our most powerful refractive surgery procedure, correcting high degrees of myopia, hyperopia, and even astigmatism (with … More
Corneal Phaco Incision Hydration
The technique of corneal stromal hydration to help seal a phaco incision is useful to ensure a watertight incision and … More
Cataract surgery & decentered LASIK flap
We frequently have patients with a history of prior LASIK who are now undergoing cataract surgery. We have explained in … More
scleral tunnel phaco incisions
Many years ago, incisions for cataract surgery were made in the sclera, even for the small phaco incisions. The scleral … More
Compilation video: Corneal Phaco Incisions
We are starting a new feature here on CataractCoach: the compilation video, where we combine the best of many prior … More
Make 2 Paracentesis Incisions
In the USA, most surgeons use coaxial I/A for cortex removal and as such, they tend to make a single … More
Review: Sealing Phaco Incisions
A properly constructed phaco incision will allow good access to the anterior chamber for cataract surgery and then will seal … More
Learn as I coach this resident
Many ophthalmologists from around the world have asked if we offer a fellowship, externship, or clinical rotation so that they … More
Quiz: Why are there two main incisions?
Cataract Quiz: Why are there two phaco incisions in this eye? This is a routine cataract surgery and the case … More
Review: The Angle of Approach for Incisions
The angle of approach of the keratome will determine the tunnel length of our phaco incision. If the angle is … More
IOL cartridges – which one?
There are many different IOL injector systems from multiple different IOL manufacturers. It is the surgeon’s job to know the … More
Review: Why LRIs should be done at the end
Limbal relaxing incisions (LRIs) are useful for treating mild to moderate degrees of corneal astigmatism at the time of cataract … More
Cataract Quiz: Where should you make the incision?
Our phaco incisions will induce an astigmatic change in the cornea and we can use that to help achieve a … More
Manual SICS with nucleus bisection
SICS is small incision cataract surgery, and it refers to a method of manual expression of the nucleus through a … More
Review: Phaco Incision OCT Analysis
The phaco incision is part of your signature which links you to the patient’s eye forever. Your incision will forever be visible … More
Refining your Surgical Signature
It is so important for surgeons to take pride in their work. You must do a great job, or don’t … More
Review: External View of Cataract Surgery Steps
Two of the most critical steps in cataract surgery are the main phaco incision and the capsulorhexis. Properly completing these … More
Three-piece IOL: B versus C cartridge
There are two options for injecting an Alcon three-piece IOL using the Monarch injector: the B cartridge is bigger and … More
Cataract Quiz: Why did we get bleeding here?
In this resident case, the IOL is in the capsular bag, the capsulorhexis is intact, the viscoelastic has been removed … More
Phaco Incision Do-Over
In this case, the resident begins by making a phaco incision that is not good. The roof is too thin … More
Simplified Technique for LRIs
Limbal relaxing incisions (LRIs) are a great option to treat pre-existing corneal astigmatism at the time of cataract surgery. They … More
Making a Scleral Tunnel Phaco Incision
For 99% of my patients, making a corneo-limbal phaco incision is ideal. However, there are cases such as this patient … More
Cataract Surgery in Keratoconus
When a patient has keratoconus, what is different about the cataract surgery? Can you still make your phaco incision in … More
Three-Plane Phaco Incisions (Tri-Planar)
Making the phaco incision is one of the most critical steps in cataract surgery. A well-constructed incision will seal without … More
How to do Limbal Relaxing Incisions
Just about any incision in the cornea will induce some astigmatic change. We have shown how to place the phaco … More
Close Up: Technique for Phaco Incision
We have shown many videos about the importance of the phaco incision. It is part of the signature that you … More
Review: An easy way to help seal the incision
If your phaco incision is properly constructed, it will typically seal quite well without the use of sutures. We can … More
Sit temporal but operate using WTR incisions
With-the-rule (WTR) astigmatism is where the steep axis is at or near the 90 degree axis. Placing incisions on the … More
Paired Phaco Incisions to Treat Astigmatism
Cataract surgery is our most powerful refractive procedure based on the spherical power that we can correct. Anything from –30 … More
Review: Phaco Incision OCT & Live Video Analysis
The phaco incision is part of your signature which links you to the patient’s eye forever. Your incision will forever be visible … More
Review: Temporal vs Superior Phaco Incisions
Some surgeons prefer to make a superior phaco incision while others prefer a temporal approach. Is there a substantial difference … More
Cataract Surgery using a Scleral Tunnel Incision
Twenty years ago, when I did my residency training at the Jules Stein Eye Institute at the UCLA School of … 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
Solving a tough case of Hexagonal Keratotomy
Featuring guest surgeon: Arun Gulani MD from Jacksonville, Florida, USA This complex case involved a patient who underwent hexagonal keratotomy … More
Evaluating Radial Keratotomy for Cataract Surgery
Radial keratotomy (RK) is an out-dated kerato-refractive surgery where radial incisions were made in the cornea in order to cause … More
Overlay the keratome to plan out the incision
In all surgeries, you must make the effort to create a great incision, which I have previously described as part … More
Review: Making the ideal single plane incision
This is such an important step of cataract surgery that we must review it again as our residents are beginning … More
Review: How to hydrate and seal the phaco incision
A properly constructed phaco incision will allow good access to the anterior chamber for cataract surgery and then will seal … More
Take Pride in your Cataract Surgery Signature
Many ophthalmologists will perform tens of thousands of cataract surgeries during their careers and each of these procedures can improve … More
Guest Surgeon: Pre-Pocket Phaco Incision Technique
Dr. André Berger from São Paulo, Brazil has developed a new technique for creating a corneal phaco incision: the Pre-Pocket … More
Quiz: Why is the posterior capsule wrinkled?
This seemed like a totally routine case. Good incision, good capsulorhexis, efficient nucleus removal, and complete cortex removal. There was … More
External View of Critical Cataract Surgery Steps
Two of the most critical steps in cataract surgery are the main phaco incision and the capsulorhexis. Properly completing these … More
Review: 3 Rules for Making Phaco Incisions
Over the last two decades, cataract surgery has evolved from scleral incisions to corneal incisions, from retrobulbar anesthesia to topical … More
Quiz: It’s a good incision so why did the AC collapse?
Quiz time! Watch this brief video carefully and figure out why the anterior chamber collapsed after this resident surgeon made … More
Learning to be consistent: 12 consecutive incisions
We aim to be consistent in our surgeries so that we can make a well-constructed incision each and every time. … More
Review: Phaco Incision paired with LRI for Astigmatism Correction
We know that the phaco incision will cause some degree of corneal flattening and this has the ability to alter … More
The IOL is stuck in the incision! What should we do?
This valuable teaching video was submitted by an anonymous resident who is still in training. In this surgery, a smaller … More
The ideal Angle of Approach for the phaco incision
The angle of approach of the keratome will determine the tunnel length of our phaco incision. If the angle is … More
Review: How to make a single-plane phaco incision
Many of the more advanced cataract surgeons prefer a single-plane phaco incision because its consistent architecture makes for great sealing. … More
Phaco Incision OCT & Live Video Analysis
The phaco incision is part of your signature which links you to the patient’s eye forever. Your incision will forever … More
How to suture the Phaco Incision with 10-0 Nylon
This video is special because we have two different camera angles: the view through the operating microscope as well as … More
Position your phaco incision to nick limbal vessels
I saw a patient recently who had femtosecond laser assisted cataract surgery a month prior by an unknown surgeon. The … More
Converting from Phaco to Manual ECCE Surgery
While it is rare, there are times when it is important to convert from a phaco approach to a manual … More
Left-Handed versus Right-Handed with Phaco Incisions
It can be helpful to place our phaco incisions on the steep axis of cornea astigmatism in order to provide … More
Bleeding in the Anterior Chamber during surgery
It is unusual to encounter bleeding in the anterior chamber during cataract surgery, but rarely it does happen. The typical … More
The incision and capsulorhexis are your signature
I like to think of the phaco incision and the capsulorhexis as my “signature” on every cataract surgery that I … More
Never make your phaco incision like this!
In this anonymous video we have a phaco incision that is very poorly made. The placement is too far from … More
Cataract Surgery in a younger patient with prior PPV
As we demonstrated recently, cataract surgery in a younger patient (under age 50) can be different than in the typical … More
If your incision has bad construction, try again
As you are making your phaco incision, judge the architecture and if it is not good, then stop and do … More
Suture Complications after Cataract Surgery
Depending on the size and architecture of our incisions for cataract surgery, sutures may be required to ensure adequate closure … More
Exquisitely sharp blades are needed for eye surgery
The eye is like an under-inflated balloon: the low pressure inside allows it to absorb most jabs without being punctured. … More
Proper Form for using a Keratome Safely & Precisely
you must learn proper form for keratome use in cataract surgery
Good versus Bad Corneal Phaco Incisions with OCT
The phaco incision is critical to the success of the cataract surgery. It gives us controlled access to the cataract, … More
OCT analysis of a corneal phaco incision
For teaching my resident surgeons who are completing their years of ophthalmology training at our UCLA hospitals, we have recently … More
Descemet Detachment at the Phaco Incision
When we construct our corneal phaco incisions, we must be careful to give them the proper architecture and form. We … More
An easy way to help seal the phaco incision
If your phaco incision is properly constructed, it will typically seal quite well without the use of sutures. We can … More
How far into the eye do you insert the keratome?
When making your phaco incision, it is important to have the appropriate tunnel length as well as incision width. We … More
Match the Phaco Incision to the Limbal Relaxing Incision
We know that the phaco incision will cause some degree of corneal flattening and this has the ability to alter … More
Making the Ideal Single-Plane Phaco Incision
Many of the more advanced cataract surgeons prefer a single-plane phaco incision because its consistent architecture makes for great sealing. … More
Complete Toric IOL Case: from Marking to Alignment
Toric IOLs allow us to surgically treat corneal astigmatism at the time of cataract surgery thereby providing our patients with … More
Shifting the Phaco Incision to treat Astigmatism
Our phaco incisions always have some degree of astigmatic effect by causing relaxation of the corneal curvature at that axis. … 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
Hydration & Sealing of Corneal Phaco Incisions
A properly constructed phaco incision will allow good access to the anterior chamber for cataract surgery and then will seal … More
Dealing with Conjunctival Chemosis
We have covered the topic of the rules for an ideal phaco incision and one of them is to barely … More
Technique for using Diamond Keratomes
Diamond keratomes are my favorite instrument for creating the main phaco incisions because they are exquisitely sharp and they make … More
Cataract Surgery after 20-cut Radial Keratotomy
We have covered the topic of cataract surgery in eyes with prior radial keratotomy (RK) but this case is unusual … More
Temporal vs Superior Phaco Incisions
[Click link below for full video] Some surgeons prefer to make a superior phaco incision while others prefer a temporal … More
Slow Motion Analysis of Phaco with EDOF IOL
Among our most popular features is the slow motion analysis of cataract surgery: when we slow down the video, we … More
Why did we get a Phaco Wound Burn?
The cornea is a very delicate tissue: it’s thin, clear, avascular, and susceptible to damage, particularly from the heat that … More
Femto Laser Incisions: Good or Bad?
The femtosecond laser is a powerful tool for ophthalmic surgery. While its use in creating corneal refractive surgery is widely … More
What is the secret to a perfect capsulorhexis?
When I examine an eye that had previous cataract surgery years ago, I see two things: the incision and the … More
Slow Motion Analysis of Cataract Surgery
There is a lot to be learned from slow-motion analysis and this applies to cataract surgery as well. Think of … More
3 Rules for Maneuvering Instruments in the Eye
Intra-ocular procedures pose the surgical challenge of working within a very small space with limited room in which to maneuver … More
3 Rules for making Phaco Incisions
A well-constructed corneal/limbal phaco incision will improve your cataract surgery technique and provide better results for your patient. (scroll down … More
Older Surgical Techniques Still Matter
Yes, I love phaco too, but we should all learn to do SICS as well. (Classic ECCE teaching video below) This … More
On-Axis Paired Incisions for Astigmatism
Don’t have a toric IOL? Try this technique to help address astigmatism at the time of cataract surgery.