Review: Why is Phaco Chop not working?

This patient certainly needs cataract surgery because the dense nucleus has a large degree of central opacity and that has … More

The Chopper Push Technique

Watch this video carefully and you will see that the chopper instrument is used just once to create a single … More

Complete Case: Chop in the Bag

Again we have a complete case, from start to finish, showing a routine cataract surgery with a phaco chop technique. … More

You must learn this before finishing residency

The challenge of residency training is that you have just a limited time to learn surgery. You can read books … 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

Cataract Quiz: The chop failed. Now what?

Even for expert cataract surgeons, sometimes the attempt at phaco chop fails. This can be due to many reasons and … More

Trap a dense nucleus in order to chop it

With a very dense and fibrous cataract, using just the vacuum from the phaco tip to hold the nucleus is … More

Phaco Chop in patients over age 90

In previous videos we have explained the differences when operating on nonagenarian patients. These patients have weaker tissues such as … More

Complete Case: Brunescent & White Cataract

This patient truly needs our help. She developed a cataract in the right eye a few years ago and was … More

Review: Side View of Hand Position

While we do hold the phaco probe with a pencil grip, we do not use the same angle as writing with … More

Trouble learning phaco chop? Try this first

One of the main reasons why phaco chop is more difficult to learn than divide-and-conquer is that there is a … More

Struggling with Phaco Chop? Let me help you

I will be the first to tell you that mastering phaco chop is not easy, but it is certainly worth … More

How far do you insert the Chopper for Phaco Chop?

A young surgeon who is new to phaco chop asked me how deep to insert the chopper tip into the … More

Resident Surgeon Learning to do Phaco Chop

In your quest to learn phaco chop, it is helpful to watch other beginning surgeons perform the same technique. In … More

Highly Efficient Stop-and-Chop

From watching videos here on CataractCoach.com, you’re aware that my favorite method of nucleus division is phaco chop. Any form … More

Review: External View of Phaco Chop

Most of the videos on this site are taken through the operating microscope. This gives the view of exactly what … More

The chop failed, so I reverted back to this…

The benefit of learning many different phaco techniques is that you can choose the one that is best for each … More

Learning Vertical Chop

Vertical chop means that both the phaco probe and the chopper are placed within the capsulorhexis and then both are … More

Slow Motion Phaco Chop

In the course of giving lectures across the USA and around the world, I meet many experienced ophthalmologists who find … More

Guest Surgeon Phaco Chop Technique

One of the hallmarks of a good surgeon is the ability to learn from other surgeons. In this case we … More

Mastering Divide-and-Conquer Phaco

Back by popular demand! Most beginning surgeons start by learning divide-and-conquer as the primary method of nucleus division for cataract … More

Quiz: Why is this phaco chop going to fail?

Look at this photo carefully. We can tell that this phaco chop will fail and the nucleus will not be … More

Cataract Surgery in a 100-year-old patient

We should all be so lucky to live to 100 years old. It’s quite a rarity and it is something … More

Cataract Surgery after Corneal Transplant

Cataract surgery in an eye with a prior corneal transplant is more difficult and there are challenges which can alter … 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

Guest Surgeon “Submarine Chop”

We all learn from each other and today’s video is a great example of that. We are learning from Dr. … More

Cataract Surgery prior to Glaucoma Surgery

We know that this patient will be undergoing glaucoma surgery in the near future and you are doing the cataract … More

Review: Learn Horizontal Phaco Chop

The original phaco chop technique described by Dr. Nagahara in 1995 was the horizontal chop. This involves holding the lens … More

Evaluation of a resident chop technique

This video was submitted by a resident in Asia who is still learning phaco and has upgraded to using the … More

Guest Surgeon: Phaco Chop Technique

This video was anonymously submitted by an experienced surgeon who wants us to analyze the phaco chop technique and give … More

Pre-Chopper Phaco Technique

There are many different ways to divide the nucleus during cataract surgery. Phaco of smaller nuclear fragments is easier and … More

Use the Chopper to Lift Nuclear Pieces Up

In cases where the capsulorhexis is small or where the nucleus is particularly large, it can be difficult to bring … More

Review: Embed the phaco probe without ultrasound

The classic teaching for phaco chop and quadrant removal is to embed the phaco probe into the nuclear piece by … More

Phaco Chop without using the phaco probe

This is a cataract surgery performed by a resident in training and the patient is known to have Fuchs’ corneal … More

Achieving a complete hemi-nuclear split

When performing any nucleo-fractis technique, it is imperative that the nucleus be completely subdivided prior to removing the halves, quadrants, … 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

Phaco Flip & Chop is great for Beverly Hills Cataracts

Often, the density of the nucleus and the severity of the cataract relates to the patient’s access to healthcare. In … More

Review: if the chop fails, revert to stop and chop

Sometimes we attempt to use phaco chop to divide the cataract nucleus, but we are just not able to achieve … More

Should we chop in the bag or above the bag?

Should we chop the nucleus within the capsular bag or should we bring the nucleus partially out of the capsular … More

The Chop will not propagate through the cataract

With a dense cataract, a fibrous posterior plate can develop within the lens nucleus. This makes is challenging to split … More

Vertical Chop & Horizontal Chop in the same case

Phaco chop is my preferred method of nucleo-fractis for cataract surgery. It is safe, efficient, and minimally invasive, significantly reducing … More

Tilt and Chop – a SupraCapsular Technique

Supracapsular phaco techniques are in closer proximity to the corneal endothelium, which can be damaged by the ultrasonic energy from … More

SupraCapsular Technique for Softer Nuclei

For a relatively soft nucleus, such as in a younger patient with primarily posterior subcapsular cataract changes, the supracapsular technique … More

Removing the last nuclear piece

When we break the cataract nucleus into smaller fragments, we can sometimes have one of these small pieces stuck in … More

Understanding Force Directions in Phaco Chop

Many resident surgeons find it challenging to learn the technique of phaco chop because of the force vectors which are … More

Adjust the Phaco Probe Angle during Chop

The phaco probe angle changes during the procedure. When we embed the phaco tip into the nucleus, the probe is … More

Review: Beginning Surgeon Learns Phaco Chop

You’ve seen countless videos of phaco chop, but you seem to be stuck in a mode of less efficient techniques … More

Side View shows the Phaco Probe at a flat angle

While we do hold the phaco probe with a pencil grip, we do not use the same angle as writing … More

Foot Pedal Position during Phaco Chop

Learning phaco chop will make your cataract surgeries safer, more efficient, and more enjoyable to perform. And of course, phaco … More

Foot Pedal Positions for Learning Phaco Chop

Cataract surgery requires both hands and both feet of the surgeon in order to perform the modern techniques. It seems … More

Use the chopper to protect the capsular bag during phaco

The chopper can do so much more than just divide the nucleus into pieces. The chopper can fixate the eye, … More

Review: Solution for the Dense Nuclear Posterior Plate

Looking at this image should intimidate beginning cataract surgeons: this is a whitish-brown totally opaque cataract and it is a … More

The Chop failed because the nuclear halves did not separate

The phaco chop technique is like splitting firewood: the instrument creates the initial cleavage plane which then must be propagated … More

Review: Fully Separate Nucleus after the Phaco Chop

When doing phaco chop, remember that you must still physically push apart the nuclear halves to achieve complete separation and … More

Guest Surgeon: The UltraChopper for Dense Cataracts

Professor Luis Escaf from Barranquilla, Colombia presents a case here of a dense cataract with a small pupil. He uses … More

Review: Multiple Small Chops for a Dense Cataract

In previous videos, I have shown my technique for breaking up a dense brunescent cataract with a fibrous and tough … More

I just cannot chop this cataract – you’ll never guess why!

This seemed like a routine cataract surgery, but I was wrong. I just could not seem to chop this cataract … More

Review: Four Quadrant Chop-and-Conquer

The idea behind divide-and-conquer makes a lot of sense: divide the nucleus into four quadrants which are more easily phaco-aspirated … More

Review: Cracking the Posterior Plate in a Dense Cataract

With a dense brunescent cataract, one of the primary challenges is cracking the fibrous posterior plate of the nucleus. Using … More

Embed the phaco probe in the nucleus without ultrasound

The classic teaching for phaco chop and quadrant removal is to embed the phaco probe into the nuclear piece by … More

Chopper placement is critical to nucleus division

The placement of the chopper is critically important to achieving division of the cataract nucleus with the phaco chop technique. … More

If your Phaco Chop fails, simply revert to Stop-and-Chop

Sometimes we attempt to use phaco chop to divide the cataract nucleus, but we are just not able to achieve … 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

Probe Placement to Facilitate Phaco Chop

Placement of the phaco probe and the chopper are critical to facilitating the phaco chop procedure. One of the big … More

Flip and Chop Phaco is Ideal for Routine Cases

The flip and chop phaco technique has been presented here before on many occasions because it is such an efficient … More

Use the Chopper to Push Nuclear Pieces to the Probe

The chopper is used for many different functions during cataract surgery, beyond just chopping the nucleus into smaller fragments. Cataract … More

What beginner mistakes do you see in this pic?

Learning intra-ocular surgery is not easy and it can take years just to be comfortable with just the basics. Look … More

Resident Surgeon Struggles with Phaco Chop

In this anonymous video, a resident surgeon struggles with phaco chop. It is not an easy technique to learn, which … More

Beginning Surgeon Learns Phaco Chop – so can you!

You’ve seen countless videos of phaco chop, but you seem to be stuck in a mode of less efficient techniques … More

Expert Technique: Small Pupil & Dense Cataract

Very experienced surgeons never rest — they are always looking to learn more. Like you, I learn a lot from … More

After the chop, you must physically separate the nucleus

When doing phaco chop, remember that you must still physically push apart the nuclear halves to achieve complete separation and … More

Pre-Chop the Nucleus to Help a Novice Surgeon

Today we have a video of a novice surgeon operating together with an experienced surgeon. The key maneuver in this … More

How to Split the Cataract if the Chop is incomplete

Sometimes when we perform phaco chop, the lens does not fully divide. The chop scores and partially splits the nucleus, … 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

Horizontal Phaco Chop for Efficient Cataract Surgery

The original phaco chop technique described by Dr. Nagahara in 1995 was the horizontal chop. This involves holding the lens … More

Hydro-delineate if the Capsulorhexis appears small

In this picture, the capsulorhexis appears to be on the small side, but it is actually just about perfect with … More

Use Multiple Small Chops for a Brunescent Cataract

In previous videos, I have shown my technique for breaking up a dense brunescent cataract with a fibrous and tough … More

Learning from an External View of Phaco Chop

Most of the videos on this site are taken through the operating microscope. This gives the view of exactly what … More

Persistence during Phaco Chop is critical

It is critical that you not give up on phaco chop as a technique but also within a surgical procedure. … More

Vertical Chop Technique for Efficient Surgery

The vertical chop technique is a favorite of mine, particularly when there is sufficient nuclear density to allow the chop … More

Switching from Vertical Chop to Horizontal Chop

Sometimes cataract surgery is like playing basketball or soccer: you know many different techniques and special moves, but the key … More

Use the Chopper for Hemi-Nucleus Management

The chopper can do so much more than chop. It can be used to fixate the eye via the paracentesis, … More

Four Quadrant Chop & Conquer Technique

Many ophthalmologist in training start out by learning the four quadrant divide-and-conquer technique, which has a long history of being … More

Why did this Phaco Chop fail to split the cataract?

In order to do a successful phaco chop, we need to make sure that the high vacuum level of the … More

Why you MUST learn Phaco-Chop (Resident Case)

A critical part of being an accomplished ophthalmologist is keeping up with the advances in your field. For cataract surgery, … More

Cracking the Posterior Plate in a Dense Cataract

With a dense brunescent cataract, one of the primary challenges is cracking the fibrous posterior plate of the nucleus. Using … 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

One-Chop Technique for Phaco Surgery

For a cataract with moderate nuclear density, splitting the nucleus into two halves can be sufficient for removal with phacoemulsification. … More

Management of the Hemi-Nucleus in Cataract Surgery

Whether you do phaco chop or stop-and-chop, you will be left with two halves of the nucleus which then need … More

Lifting the nucleus up though a small pupil

Here at CataractCoach, we have featured videos showing how to hydro-dissect a nucleus up, out of the capsular bag and … More

Adapting your Phaco Chop Technique to each Eye

I encourage ophthalmologists in training to learn multiple different nucleo-fractis techniques so that they can tailor the cataract surgery to … More

Solution for Incomplete Phaco Chops

You’re an experienced phaco chop surgeon and you come across a case where you just cannot get the chop to … More

Routine Dense White Cataract Surgery

Finishing up our week of routine cataract cases, today we are reviewing dense white cataracts. In some parts of the … More

Routine Phaco Chop Cataract Surgery

Continuing with our series about routine cataract cases, today we present a routine phaco chop surgery. The cataract is chopped … More

Routine Flip-and-Chop Cataract Surgery

We have previously featured an instructional video for the Flip-and-Chop method of cataract surgery and there was a very strong … More

Why I love Routine Cataract Cases

Many of the articles and videos here at CataractCoach.com feature unusual, difficult, or challenging cataract cases. These are fun videos … More

Cataract Surgery after Prior Vitrectomy

Cataract surgery in an eye which has undergone a prior pars plana vitrectomy is different in many ways, including lens … More

Pre-Chopper Technique for Phaco Surgery

The Pre-Chopper instrument was developed by Takayuki Akahoshi MD from Japan and it allows the cataract nucleus to be divided … More

Nucleus Chop with a 27g Cannula

It is the beginning of the academic year, which in the USA runs from July 1 (start) until June 30 … More

Flip and Chop early in the Learning Curve

Phaco Chop is my preferred technique of nucleus removal during cataract surgery because it is safe, efficient, and uses much … 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

Slow Motion Analysis of Phaco Chop

When we are watching a cataract surgery video to learn techniques from others, it is often difficult to understand the … 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

Stop-and-Chop Technique for Cataract Surgery

The Stop-and-Chop technique for nucleus removal during cataract surgery blends aspects of the Divide-and-Conquer method with some Phaco Chop. Some … More

Why is phaco chop not working here?

This patient certainly needs cataract surgery because the dense nucleus has a large degree of central opacity and that has … 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

White Cataract: What is USA Flag Sign? (Hint: Femto)

The USA Flag Sign is seen when we use a femtosecond laser to assist in phaco of a white cataract. (scroll … More

White Cataracts: They are not all the same!

You’ve seen the notation in the patient chart: “DWC” which stands for Dense White Cataract, but there is actually a … More

Cataract Surgery with Pupil Stretching

No need for pupil expansion rings or iris hooks for many cases (full video below) Yesterday’s video about dealing with … More

Pseudo-Exfoliation Cataract Surgery

Pseudo-Exfoliation / Small Pupil / Weak Zonules / Shallow AC (watch video below) A sweet 80 year old patient comes … More

Heterochromia Iridis Cataract Surgery

Heterochromia iridis is a condition where there are two different iris colors, usually one eye being darker than the other. … More

Posterior Polar Cataract: Expert Level with Small Pupil, Floppy Iris, Dense Lens

Yesterday’s video showed the technique of using Visco-Dissection to aid in surgery for posterior polar cataracts. That patient had a … More

Phaco Flip and Chop Technique

The phaco flip technique is when the nucleus is prolapsed out of the capsular bag and then emulsified at the … More

Combo Chop: Combining the Advantages of Horizontal and Vertical Phaco Chop

Phaco chop revisited: Combo-chop combines horizontal and vertical chop techniques Combining the advantages of the two techniques can simplify the … More

Cataract Surgery and Pterygium Avoidance

(scroll down to see the full narrated surgical video) In most patients who have both a pterygium and a cataract, … More

Cataract Surgery with Prior LASIK

With age, everyone who lives long enough will develop a cataract. This means that today’s LASIK patients will someday need … More

Cataract Surgery with a Mid-Size Pupil without using iris hooks or expansion devices

How do we do cataract surgery in an eye with a mid-sized pupil of about 3 or 4 mm in … More

Approach to the Dense Brunescent Cataract

With Increased Nuclear Density comes Increased Risks Here is how to successfully approach these tough cataract surgery cases: Patients with … More