Descemet’s Membrane Detachment

When we make a corneal incision for cataract surgery, we must be careful to avoid damaging the attachment of Descemet’s … More

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

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

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

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 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.