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