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Cataract Coach

Professor Uday Devgan MD, renowned Los Angeles cataract surgeon, teaches the Best Techniques for Cataract Surgery. All Content © 2018-2021 Uday Devgan

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Category: IOL related

1011: Opacified IOL Exchange

While it is rare, some IOLs can become opacified with time. This has been reported primarily with hydrophilic acrylic materials … More

iol exchange, opacified IOL

1003: Why did the patient go elsewhere?

This video shows two complete surgeries, both presented at high speed. The original cataract surgery was performed by me and … More

iol exchange

iris claw lens to address aphakia

Another excellent video from our colleague Dr. Val Apostolov from Amsterdam. In this case there is a patient with a … More

cataract surgery, iris claw lens

highly myopic cataract surgery

These are some of the most rewarding cataract surgeries to perform since we can correct the cataract as well as … More

cataract surgery, high myopia

Recovering from misloaded IOLs

We count on our surgical techs and assistants to help with certain parts of the cataract surgery. One of these … More

cataract surgery, misloaded IOL

Extended Depth of Focus: Alcon Vivity

We all want to be young again, at least when it comes to vision: visual quality, range of vision, and … More

alcon vivity, cataract surgery, EDOF

IOL design differences

We have many different IOL designs available for use in cataract surgery and even within the most popular category (single-piece, … More

IOL design, IOL differences

Fixing IOL-induced UGH Syndrome

UGH syndrome is the triad of uveitis, glaucoma, and hyphema which all can be induced as a complication from sulcus … More

UGH syndrome

Twist and Out to Explant IOLs

I first saw Jack Chapman MD explain his technique to explant an IOL at a large ophthalmology meeting about 10 … More

iol exchange

How to dissect the IOL out of the bag

When we are doing an IOL exchange, the first step is to carefully dissect the old IOL out of the … More

iol exchange

Cataract Quiz: What happened here?

Our quiz features a video from Gustavo Hüning, MD, MBA from Brazil and it shows an unusual situation that happens … More

cataract quiz

Angle Alpha and Angle Kappa with IOLs

If an IOL has zero power, such as in an extremely myopic patient, where we place it in the eye … More

angle alpha, angle kappa

compilation video: IOL exchange

Every cataract surgeon needs to learn how to perform an IOL exchange because, although it is rare, we sometimes need … More

iol exchange

compilation video: suture-fixated IOLs

This video features all sorts of suture-fixation techniques for securing IOLs in cases where there is limited or no capsular … More

sutured IOL

Equanimity under Duress

When Sir William Osler left the University of Pennsylvania’s Medical School (the first one in the USA, started in 1765) … More

cataract surgery

Review: Yellow versus Clear Optics

There has been much debate about the light transmission properties of various IOL optic designs. While most IOLs have a … More

yellowIOL

Cataract Quiz: What’s wrong with the IOL?

Time for a Cataract Quiz, featuring guest surgeon Dr. Sourabh D. Patwardhan from India, featuring a complication with an IOL. … More

cataract quiz

Fixing severe capsular phimosis

In a small number of patients, capsular phimosis can happen after cataract surgery. This can lead to severe distortion of … More

cataract surgery

Lessons Learned with 3-piece IOLs

Most cataract surgeons now use single-piece acrylic IOLs for the majority of their cases, with three-piece IOLs reserved for unusual … More

#cataract, #cataract surgery

Cataract Quiz: IOL with capsule tear

Cataract Quiz time: you have removed the lens nucleus and the cortex and you see that the anterior capsular rim … More

#cataract, #cataract surgery, cataract quiz

Should you use a trifocal IOL in Fuchs’?

This is an unusual case: the patient has Fuchs’ Corneal Dystrophy and yet we are implanting a trifocal IOL. Usually, … More

#cataract, #cataract surgery

Review: Small Eye with high power IOL

Cataract surgery can provide an incredible refractive result, particularly for small eyes which are highly hyperopic. We can correct 10 … More

#cataract, #cataract surgery

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

#cataract surgery, iol cartridge

Cataract Surgery with Asteroid Hyalosis

Asteroid hyalosis is a rare condition where patients have calcifications throughout the vitreous jelly. It occurs in about 1-2% of … More

#cataract, #cataract surgery, asteroid

Scleral-sutured IOL with GoreTex

This is an unusual case of prior trauma. A 13 year old boy was playing with fireworks and sustained a … More

#cataract

IOL delivery technique

While it seems relatively easy to insert the IOL with an injector system, there are subtleties in the technique which … More

#cataract, #cataract surgery

Mastering IOL Flange Techniques

In cases of insufficient zonular support, using a flange technique has become popular after Dr Shin Yamane shared his technique … More

Cataract Quiz: Optic-Iris Capture

Happy New Year! It’s Quiz Time: how do you approach this case with optic-iris capture and a dense fibrotic membrane? … More

Cataract Quiz: What is the problem here?

Time for another Cataract Quiz. Look carefully at the photo — the IOL has just been implanted and now it … More

The surgeon will struggle to finish. Why?

In this resident surgeon case, the anterior chamber flattens and there is loss of viscoelastic upon attempted manipulation of the … More

Cataract Quiz: Why is there a capsular wrinkle?

This surgery seemed quite routine. A nice capsulorhexis, easy nucleus removal, and complete cortex clean-up. The three-piece IOL was placed … 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

Why implant a zero power IOL?

This patient is ultra-myopic with an axial length of more than 31 mm. Using the free calculator at IOLcalc.com we … More

Cataract Quiz: Why is this cortex so adherent?

This seemed like a completely normal case… until it came time for removal of the last bit of cortex, which … More

Cataract Quiz: What complication will happen next?

Cataract Quiz: look carefully at the IOL in the injector cartridge. Now it’s time to implant the IOL into the … More

Guest Surgeon PanOptix Tips & Tricks

In the USA, we often get access to new technologies later than other countries due to the hurdles required to … More

Clear Optic versus Yellow-Tinted

There has been much debate about the light transmission properties of various IOL optic designs. While most IOLs have a … More

Initial Review of the Alcon PanOptix IOL

The Alcon PanOptix IOL has been available in the USA for about three months. What are our initial impressions? How … More

Review: Understanding Purkinje Images

Intra-ocular lens implants which are well-centered can provide better quality of vision for our cataract surgery patients. In the ideal … More

Quiz: What is happening in this eye?

Look carefully at this photo taken at the slit-lamp microscope. What is happening in this eye? Describe what you see … More

Learning Surgical Pearls from Colleagues

There are all sorts of surgical pearls that we can learn from our colleagues. Different techniques and methods of making … More

Review: How to Handle IOL Haptic Twist

When we inject a three-piece acrylic IOL into the eye, we must be very careful to ensure that the IOL … More

Quiz: What is going on with this IOL haptic?

The surgery has gone very smoothly and the senior resident is doing a great job. The incisions are good, the … More

Resident surgeons must learn to load the IOL

The surgeon must know how to do every single part of the surgery, including setting up the phaco machine and … More

Alcon PanOptix Trifocal IOL Performance

In the USA, the FDA has recently approved the Alcon PanOptix IOL for use in cataract surgery. This is a … More

Cataract Surgery with High Power IOL placement

Cataract surgery can provide an incredible refractive result, particularly for small eyes which are highly hyperopic. We can correct 10 … More

Cataract surgery & Phakic IOL removal

Posterior chamber phakic lens implants can effectively treat a large degree of myopia while retaining the accommodation of a youthful … More

Capsular Tension Rings in Cataract Surgery

Capsular tension rings are flexible plastic loops which are designed to exert outward force at the capsular bag equator to … More

Which viscoelastic for the IOL injector?

We know that a dispersive viscoelastic will protect the corneal endothelium better during phacoemulsification of the lens nucleus. And a … More

Does age make a difference in IOL surgical planning?

We have some amazing surgical technology now with IOLs that give a wide range of vision and can even help … 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

Review: How to load and inject a single-piece IOL

Let’s review a routine case, this time with a toric IOL. All surgeons in training must know how to properly … More

Quiz: What is the Problem that you see here?

This video has been sent to us by an anonymous resident surgeon in training. During this case there was a … More

Options for IOL Explant: Twist or Cut

In rare cases, we may need to explant the IOL and replace it with a different IOL for a different … More

Switching from a Toric IOL to a spherical sulcus IOL

We recently featured a four-part series of a single, complicated cataract case in which the phaco probe punctured the posterior … More

Posterior Capsule Break with a Toric IOL in the bag

The posterior capsule sustained a break during phaco which was near the capsular bag equator and not immediately noticeable to … More

IOL Calcs: PLUS Precision Ladas Universal Superalgorithm

The future of IOL calculations is with methods that can evolve. A static formula is a time-limited method which will … More

Basics: How to Load and Inject a Three-Piece IOL

In the USA, the most commonly used IOL in routine cataract surgery is a single-piece acrylic IOL. These IOLs work … More

Quiz: What is the problem here? Look Carefully!

This case seemed like a routine cataract surgery. Everything went smoothly. A good incision, a nice round capsulorhexis, easy removal … 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

We must Align and Center a Toric Diffractive IOL

With new technology IOLs, we have the ability to address corneal astigmatism as well as provide a wide range of … More

LensGen Juvene IOL presentation from 2019 ASCRS meeting

For those of you who missed the 2019 ASCRS Meeting (American Society of Cataract & Refractive Surgery) meeting in San … More

Quiz: Why won’t this IOL stay centered?

This case seemed 100% normal. Reasonable dilation, good zonular support, 5-mm round capsulorhexis, phaco chop, and a normal capsular bag. … More

Old IOL explanted, then new IOL sutured to the Iris

This patient had a prior cataract surgery with a single-piece acrylic IOL precariously placed into a compromised capsular bag. This … More

Why Lens Geometry is important for IOL Calcs

The geometry of the IOL is important for IOL calculations and it must be taken into consideration. Yet, we learn … More

Quiz: Which ACIOL is in the correct orientation?

An anterior chamber IOL (ACIOL) is rarely used, but in cases with no capsular support, it can be very helpful … More

Dual Optic, Curvature Changing, Full Range Presbyopic IOL

Imagine an IOL for cataract surgery that mimics the human lens with the ability to give a wide range of … More

Why implant an IOL if the power is Zero?

Sometimes, in a very myopic eye, the desired IOL power will calculate to zero diopters. An IOL of zero diopters … More

Would you implant a CTR: Capsular Tension Ring?

This challenging cataract case has loose zonular architecture globally, not focally. There is no prior trauma and there is not … More

Quiz: Why does the IOL optic look cloudy?

This patient had cataract surgery with the same IOL about 18 years ago and she did very well for many … More

Misloaded IOL rips open the posterior capsule

An anonymous surgeon submitted a video of a complication that happened with a misloaded IOL injector. We are thankful for … More

Twist Technique to Easily Explant the IOL

There are times when we need to explant an IOL from the eye. This can be at the time of … More

What is the 7L rule for haptic orientation?

You must know instantly if the IOL is being implanted in the eye correctly. We have explained how the IOL … More

Inject more OVD before manipulating the IOL

When we insert the IOL, sometimes viscoelastic will be lost via the main incision. This can happen if we gape … More

Technique to suture an IOL to the iris

Sometimes, the IOL can dislocate after surgery and in the case of a three-piece IOL, we can easily suture the … More

Controlled IOL delivery during Cataract Surgery

In the past few days we have shown cases where the IOL delivery was less than ideal. This resulted in … More

Misloaded IOL leads to fractures of the optic

In this case, an ophthalmologist in training is performing this surgery during his residency program. The case looks great, but … More

Misloaded IOL shoots out of the injector

The new scrub technician was working with us for the first time. She had previously assisted with ophthalmology surgeries in … More

Mystery Case: What are these linear marks?

You’re doing a routine case and it is progressing beautifully. A good incision, a centered 5-mm capsulorhexis, efficient nucleus removal, … More

Which direction do you rotate the IOL?

Which way should you rotate the IOL, clockwise or counter-clockwise? The answer is… it depends. If the IOL haptics are … More

Important Lesson from a Misloaded IOL

I had a case recently, where the surgical assistant told me that he was having difficulty loading the IOL into … More

Why did the IOL Haptic get stuck to the Optic?

  We use thin IOLs which are then placed into injectors which roll, fold, or compress the them so that … More

How to inject a 3-piece IOL when the haptics twist

When we inject a three-piece acrylic IOL into the eye, we must be very careful to ensure that the IOL … More

Tips & Tricks for High-Power IOL Delivery

A high-power IOL is not the same as an IOL with an average power, primarily because the increased power of … More

Phaco Chop with Surgeon-Loaded Toric IOL

Yesterday’s video was a complete toric IOL case from marking to alignment, however the IOL was loaded by the technician … More

How to deal with a Mis-loaded IOL

There are occasions when we will be handed an IOL which has been loaded incorrectly into the injector system. It … More

Using Purkinje Images for IOL Centration

Intra-ocular lens implants which are well-centered can provide better quality of vision for our cataract surgery patients. In the ideal … More

Wound-Assist Technique for IOL Delivery

The switch from large-incision manual extracap cataract surgery to smaller-incision phacoemulsification was helped tremendously by the advent of foldable IOLs. … More

Can we prevent negative dysphotopsia?

Jack Holladay, MD, MSEE was instrumental in describing the causes of negative dysphotopsias with his enigmatic penumbra explanation. Sam Masket … More

Cataract Surgery with Traumatic Zonular Loss

Are you ready for a challenge? This patient is a relatively young construction worker who sustained a blunt traumatic ocular … 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

Routine Toric Case with Surgeon-Loaded IOL

  Again, time to learn from a routine case — this is the type of case that is your “bread … More

Comparison of Night Vision with Different IOLs

Patients often ask me if any of the new lens designs will give them youthful vision. The truth is that … More

Should you do a Primary Piggyback IOL?

In highly hyperopic eyes and nanophthalmic eyes the required IOL power can be very high, sometimes in excess of +40 … More

Single-Piece Acrylic IOL Injector Loading

All beginning cataract surgeons must know how to load the IOL into the injector for cataract surgery. While this seems … More

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