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