2003: fix synechiae with a pale blue iris

In my private practice many patients have light colored irides with scant pigmentation. The iris stroma tends to be very … More

1951: small aperture IOL with prior 16-cut RK

This is another radial keratotomy patient (RK) with 16 cuts in the cornea. These are not the cleanest cuts and … More

1925: pupil stretching is safe, easy, effective

Performing pupil stretching is safe, easy, and effective but there is a delicate balance. Too forceful of a stretch can … More

1920: small pupil pseudo-exfoliation

Our guest surgeon does a great job with this tough case of pseudo-exfoliation with a relatively small pupil. And this … More

1908: nanophthalmos & decompression

This patient has true nanophthalmos with an axial length of less than 20mm and a calculated IOL power of 67 … More

1879: small pupil, synechiae, dense cataract

These types of cases where there is a small pupil due to posterior synechiae can be challenging. We must first … More

1867: pinhole pupilloplasty technique

Patients are often amazed by the magic of the pinhole in addressing refractive issues when we check visual acuity in … More

1855: MSICS with small pupils & weak corneas

All this week we are featuring cases of MSICS: manual small incision cataract surgery. The incision is not all that … More

1850: ASCRS 2023 Course Case 9

On Sunday, May 7, 2023 we had our Best of CataractCoach.com course at the ASCRS meeting in San Diego. It … More

1820: monocular with pseudo-exfoliation

Ophthalmologists are very familiar with pseudo-exfoliation syndrome since it makes the cataract surgery more challenging due to poor dilation or … More

1819: curriculum lesson 22: small pupil & iris prolapse

The next lesson in our 25 part curriculum series is focused on dealing with small pupils and iris prolapse. You … More

1817: My Week: How do I get the nucleus up?

Many readers have asked for pearls in getting the nucleus up, part way out of the capsular bag, and in … More

1748: tiny hyperopic eye & small pupil

Just watching this case is stressful. It is a very small eye with a 20 mm axial length, shallow anterior … More

1713: pars plana tap for aqueous misdirection

The key to resolving iris prolapse is to release the pressure gradient and we have covered this topic many times … More

1705: recovering from iatrogenic iris damage

This is a very tough case and the iris prolapse and damage is considerable. This is the type of case … More

1701: don’t just break synechiae, fix pupil

This patient had a prior history of anterior uveitis which resulted in the formation of synechiae from the iris to … More

1681: your advice for this young doctor

Time for a group effort from out CataractCoach fans: this young surgeon has submitted case 100 and asks for our … More

1680: successful small pupil MSICS

Our guest surgeon has a lot of experience in performing MSICS, even in a tough case like this with a … More

1673: lift the iris in a small pupil case

For patients with smaller pupils, such as this case with about a 4 mm pupil diameter, I tend not to … More

1667: case 2500 small pupil, no ring needed

Many surgeons will see this small pupil and immediate ask for a pupil expansion ring or iris hooks and that … More

1663: resident fixes synechiae small pupil

This small pupil case has a surprise in store for you. The patient has a history of prior uveitis which … More

1662: expansion ring for small pupils

Happy Thanksgiving to my USA followers – my favorite holiday of the year because we express our gratitude for the … More

1645: phacolytic glaucoma & synechiae

Our guest surgeon does a great job with a very difficult cataract surgery. The patient has phacolytic glaucoma where the … More

1632: sphincterotomy & bag handle

The two techniques shown in this video have not been previously featured on CataractCoach and since they are from the … More

1621: is it ok to do phaco in the AC?

Many years ago when phaco techniques were first being developed, some surgeons elected to do phaco in the anterior chamber. … More

1572: solving iris prolapse in a small eye

Our guest today is Dr Mohamed Sayed (formerly in Miami, now in Dubai), a master surgeon who has taught us … More

1557: small pupil and dense cataract

This is a fun video where I give the commentary while watching it for the first time. The case is … More

1514: “the toughest case of my life”

“The toughest case of my life” is quite a statement when it is said by a highly experienced, expert level … More

1454: peeling off the pupillary membrane

This patient has a long history of prior uveitis / anterior iritis which caused synechiae where the iris became adherent … More

1407: challenging uveitic cataract

This patient is monocular and has an opaque cataract that developed in the setting of chronic uveitis. This has cause … More

1403: tips & tricks for using iris hooks

Iris hooks are very useful for expanding the pupil during cataract surgery. The iris hooks have an advantage over pupil … More

1392: MSICS with a small pupil

You must be wondering why I have been posting so many MSICS (manual small incision cataract surgery) videos in the … More

1388: small eye, small pupil, dense cataract

This is a very tough case: a small eye with a shallow anterior chamber, a small pupil with iris laxity, … More

1359: pupil stretch without iris damage

We can stretch the pupil using two hooks in order to enlarge a small pupil for cataract surgery. But how … More

1353: this means no pupil ring needed

There are some cases where you absolutely need a pupil expansion ring or iris hooks, such as this case. That … More

1348: pupil stretch, toric IOL, steroid implant

Our guest surgeon Dr Himani Goyal does a masterful cataract surgery for this monocular patient. We are showing the entire … More

1329: pupil expansion with iris speculum

Our guest surgeon today is showing a different type of pupil expansion ring. It is made of metal and it … More

1326: operating through a small pupil

Our guest surgeon is highly talented and from watching this surgery, I suspect has done many thousands of cataract surgeries. … More

1305: synechiolysis in traumatic cataract

These synechiae are adhesions of the iris to the anterior lens capsule and in this case, they are due to … More

1290: uveitic cataract with synechiae

Our guest surgeon presents a patient with a long standing history of uveitis who has developed an opaque cataract. In … More

1284: Pupil Stretching Works!

Pupil stretching works. And it works well without additional instrumentation or devices. In this example the pupil went from 3.9 … More

1256: you don’t need a pupil ring

If you are still a beginning surgeon or a resident surgeon, there may be a tendency to use pupil expansion … More

1200: small pupil toric IOL case

These are my pearls for implanting a toric IOL and achieving accurate alignment in small pupil cataract cases. These cases … More

1194: phaco use after IOL implanted

This is a tough case for a resident. A smaller pupil with a denser cataract and in an eye with … More

1157: Malyugin ring rips the lens capsule

This video shows a complication that I have never seen before: insertion of the Malyugin pupil expansion ring inadvertently rips … More

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