This video shows a complication that I have never seen before: insertion of the Malyugin pupil expansion ring inadvertently rips … More
Category: small pupil
1155: dense cataract, small pupil, MIGS
This is a tough case in an 87 year old patient who has a small pupil, a dense cataract, and … More
1151: white cataract and uveitis synechiae
This patient has a long standing history of uveitis which has resulted in synechiae between the iris and the anterior … More
1130: Pupil Expansion with B-Hex Ring
If you really want to be honest with yourself, you will agree that the B-Hex pupil expansion ring is amazing. … More
1093: Audience Poll: Pupil Ring or Not?
This is the maximum pharmacologic dilation of about 4mm and the patient is noted to be taking tamsulosin (Flomax) for … More
1082: release of posterior synechiae
Our guest surgeon shows us his technique of using a spatula to release the posterior synechiae in this eye with … More
1081: if you need iris hooks, use them
Our guest surgeon shows us a case that really benefits from using iris hooks. This video goes into the details … More
1002: Do not upset the iris!
There is a lot to learn from this resident cataract surgery. The case starts out with a reasonable pupil of … More
This sign means I need a pupil ring
this sign means that I need a pupil ring for cataract surgery
You don’t always need rings or iris hooks
For a case like this, there is no need for a pupil expansion ring or iris hooks. These devices can … More
Playlist: Small Pupil Cataract Surgery
Small pupil cases are relatively common, so all cataract surgeons must learn to master the techniques for these cases. This … More
tiny pupil and fibrotic membrane
This is a very tough case for this senior resident. The patient has a history of chronic uveitis, which has … More
Review: Uveitis, Glaucoma, Cataract
Cataract surgery in an eye with uveitic glaucoma Stepwise approach to surgical success Cataract surgery in eyes with small pupils … More
Complete Cataract Case: No pupil ring!
Another video in our series of complete cataract cases, where the entire surgery from start to finish is presented. There … More
lift the iris in smaller pupil cases
While we think that an 8 mm pupil is very well dilated, we must remember that the capsular bag has … More
Surgeon returns after a 3 month hiatus
Performing surgery at a high level is a skill that must be continually honed and practiced. What happens when we … More
Resident Cataract Case with Iris Hooks
For a small pupil case, using iris hooks is helpful to give better access during cataract surgery. This case is … 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: Management of Iris Prolapse
In this resident performed surgery, we encounter iris prolapse after too much hydro-dissection. This results in the iris prolapsing out … More
Uveitic Dense White Cataract
This dense white cataract is further complicated by being an a uveitic eye with a fibrotic membrane causing a small … More
How to: Challenging Uveitic Cataract
This patient has a long standing uveitis which is currently under control as well as uveitic glaucoma which required placement … More
Small pupil, PXF, and IFIS
For a beginning surgeon it is helpful to see surgeons performing techniques that are out of your comfort zone. The … More
Pearls for small pupil cataract surgery
There are some great surgical pearls for dealing with small pupils during cataract surgery and this video explains some of … More
Quiz: Should I have used a pupil ring?
This is a tough case and the pupil is smaller than I expected. Should I have used a pupil expansion … More
Tough cataract case for a resident
We are thankful for the many video submissions we receive from our readers, particularly from residents or registrars who are … More
Complete Case: Floppy Iris & Loose Zonules
There is a benefit to watching a video of a complete cataract case, from start to finish. This is particularly … More
Toric IOL technique with a small pupil
The toric IOL is a great option to address astigmatism at the time of cataract surgery. For the toric IOL … More
Step-by-step: Malyugin Pupil Ring
To perform cataract surgery in an eye with a small pupil, it helps to expand the pupil to a more … More
Review: Pseudo-Exfoliation Cataract Surgery
Pseudo-Exfoliation / Small Pupil / Weak Zonules / Shallow AC (watch video below) A sweet 80 year old patient comes … More
Cataract Surgery with Synechaie Lysis
Synechiae are adhesions of the iris to ocular structures which can cause issues of aqueous blockage, pupil dilation, and more. … More
Always check under the Iris
We have covered this lesson before, but it certainly is worth repeating: always check under the iris when you perform … More
Review: Check under the iris for lens material
When performing cataract surgery for an eye with a moderate or small pupil, be sure to check under the iris … More
Lysis of Synechiae and Cataract Surgery
In patients with prior uveitis, synechiae between the iris and the anterior lens capsule can develop. These adhesions will prevent … 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
Learn the Pupil Stretch Technique
Stretching the pupil during cataract surgery is a safe and effective way to improve access via mechanical dilation. While there … 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
Synechiae & Small Pupil solved with the B-Hex ring
This video features guest surgeon Neto Rosatelli MD from Brazil showing us his approach to cataract surgery in a uveitic … More
Checking under the Iris for Hidden Cortex
In cases where the pupil does not dilate fully, it can be difficult to see the entire capsular bag to … More
Higher Infusion Pressure Helps in Floppy Iris Cases
In our phaco fundamentals series, we have explained the basics of choosing fluidic parameters for the phaco machines. These settings … More
Malyugin Ring for Pupil Expansion in Cataract Surgery
A well-dilated pupil facilitates cataract surgery and if the patient has a small pupil there are multiple options for safely … More
Sometimes Even Experts Struggle during Surgery
As we gain more experience and hone our surgical skills, we achieve the state of flow where the procedure progresses … More
Guest Cataract Surgery: Tiny Pupil with Synechiae
This patient had a prior uveitic episode which resulted in the formation of posterior synechiae, where the iris, at the … More
The iris/pupil can hold the nucleus during phaco
Today we have an unedited video of a routine case in a patient with floppy iris syndrome due to Flomax … More
Ovoid Pupils in Cataract Surgery – What Happened?
What is happening in these cataract surgery patients with prior Flomax (tamsulosin) use? Why are the pupils ovoid in shape? … More
Pearls for Using Iris Hooks to Expand Small Pupils
Sometimes, the best approach to expanding a small pupil for cataract surgery is to use iris hooks. These are small, … 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
Guest Surgeon: Cataract with prior Trabeculectomy
This is a great video submitted by Dr. Mohammed Ghoneem from Alexandria, Egypt where he shows his method for successful … 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
Pupil Ring placed in one movement, but there is a catch…
I wanted to try a new technique: placing all 4 scrolls of the Malyugin ring on the iris in one … More
Small Pupil Flomax Adventures (without a ring!)
This is a really fun cataract surgery. After tens of thousands of cases, an unusual or challenging clinical situation really makes … More
Pupil Stretch using Capsulorhexis Forceps
To stretch a small pupil, you actually don’t need special instruments. Using two instruments such as choppers, hooks, or manipulators, … More
Tips & Tricks for Using Pupil Expansion Devices
While I don’t use them often, pupil expansion devices such as the Malyugin ring, are useful when performing cataract surgery … More
Check under the Iris for Hidden Cortex Material
When performing cataract surgery for an eye with a moderate or small pupil, be sure to check under the iris … 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
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
Expansion Ring for Small Pupil Cataract Surgery
For small pupil cases, I prefer to do stretching in order to expand the pupil and then I can proceed … More
Rescuing the Radialized Capsulorhexis
The capsulorhexis is an important early step of cataract surgery because it gives strength to the capsular opening so that … 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
Cataract Surgery with a very shallow Anterior Chamber
This small eye suffered from angle closure and subsequent development of a white cataract. The angle closure was successfully treated … More
Complex Cataract: multiple challenging issues
This patient had a large rhegmatogenous retinal detachment repaired a few years ago with a successful pars plana vitrectomy. The … More
Bleeding from Pupil Expander! Now What?
Pupil expansion devices can be helpful to provide sufficient dilation in cataract surgery. This video features guest surgeon Ravi D. Goel, … More
3 tricks for Small Pupil + Flomax Cataract Surgery without Expanders or Iris Hooks
Can you do cataract surgery in an eye with a small pupil without having to use expanders or iris … 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
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
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