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

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

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

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

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

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

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

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

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 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

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

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

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 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

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

IOL delivery technique

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

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