2920: small pupil case with a surprise

99% of ophthalmologists (including me!) will not be able to figure out the surprise from this picture. If you want … More

2896: resident tries pupil stretching

Mastering Manual Pupil Stretching For a resident surgeon, manual pupil stretching is a reliable, cost-effective technique to manage miosis and … More

2863: using a needle to insert iris hooks

We are always looking for ways to make our surgeries more efficient and safer, and today I want to show … More

2859: injecting trypan blue under the iris

Injecting Trypan blue under the iris: Staining in Small Pupils In cases with posterior synechiae and a non-dilating pupil, the … More

2842: tough cataract case with prior NVG

For this very tough cataract case, our guest surgeon is Dr Lucy Shen from the Mass Eye / Harvard in … More

2840: so many challenges for this resident

I am very proud of this resident for sending in this video of case 75, which is quite challenging, with … More

2718: uveitis white cataract & synechiae

Performing cataract surgery in an eye with chronic uveitis presents a triple challenge: a fragile blood-aqueous barrier, dense posterior synechiae, … More

2794: how to make a scleral tunnel incision

Clear corneal incisions have become the default entry point for routine phacoemulsification due to their simplicity, rapid healing and low … More

2748: should we do iris sphincterotomies?

Small pupils can significantly complicate cataract surgery by limiting visualization and access to the lens. When pharmacologic dilation is inadequate, … More

2720: How to deal with this small pupil?

Iris hooks are a reliable method for mechanically expanding a small pupil during cataract surgery, especially when pharmacologic dilation is … More

2658: resident case 260 with pupil ring

Our anonymous resident performs cataract case number 260 of training and uses a pupil expansion ring. The skills are good … More

2640: the secret to get the nucleus out of the bag

In cataract surgery, managing a small pupil presents several intraoperative challenges, particularly in safely prolapsing the nucleus out of the … More

2597: reverse pinhole pupilloplasty

Yesterday, our amazing CataractCoach Podcast (the top podcast in all of ophthalmology!) featured Dr Priya Narang who just won a … More

2537: inadvertent iridodialysis, hyphema

We love complication videos because they offer some of the best learning. If you want your video featured on CataractCoach™ … More

2527: three very tough monocular cases

Being a cataract surgeon is stressful and every patient demands a perfect outcome. The most challenging cases are often those … More

2474: this is going to be a tough case!

This patient has a small eye with a small pupil, shallow anterior chamber, and pseudo-exfoliation. That will make the case … More

2447: small pupil case becomes tough

When dealing with patients who have small pupils or floppy iris tissue, we need to take extra caution. Even then … More

2438: small pupil, shallow AC, stop & chop

I get emails from viewers asking how to see cases where I am the surgeon operating. This is about as … More

2436: everything, everywhere, all at once

Yesterday on the Cataract Coach Podcast (the top podcast in all of ophthalmology!) we featured Prof Bruno Trindade from Belo … More

2433: anterior capsule tear small pupil case

Another tough case where the patient has a small pupil, a dense cataract, and incessant head moving during surgery. This … More

2405: pars plana posterior capsulotomy

This patient has a dense posterior capsule opacity and also has a small pupil which does not dilate with maximal … More

2375: synechiae with 360° pupil seclusion

This patient had a history of prior uveitis which is now quiescent. This has left the eye with extensive posterior … More

2367: nanophthalmic eye challenges

We all love performing cataract surgery on average eyes because we know what to expect: an average IOL power, average … More

2292: small pupil phaco without a ring

This patient has a small pupil and cataract surgery will be more challenging in this case. We can use a … More

2264: small pupil, shallow AC, glaucoma

This cataract surgery patient has a relatively small pupil, a shallow anterior chamber, and glaucoma. Our guest surgeon does a … More

2244: the challenge of seclusio pupillae

This patient has a complex history: a 58-year-old woman with a history of severe non-infectious panuveitis, presenting with a non-dilating … More

2185: cataract surgery for a famous actress

I would bet that no other ophthalmologist has performed cataract surgery for more Academy Award® nominees and winners than me … More

2147: fix narrow angles with cataract surgery

When we replace the 4.5mm thick cataract with a thin IOL, we open the angle of the eye and solve … More

2131: small pupil: ring or no ring?

Our guest surgeon shows us the two eyes of the same patient with each having a similar pupil size and … More

2126: sphincterotomy for a tiny pupil

This patient has a uveitic cataract with a pupil membrane and synechiae which has resulted in a tiny 1 mm … More

2091: small pupil phaco without rings

Our talented guest surgeon does a great job of cataract surgery in a patient with small pupils without using a … More

2055: uveitic cataract and pupil membrane

This patient has a long-standing history of prior uveitis which has caused a fibrotic membrane to develop over the pupil. … More

2052: What is lens sparing cataract surgery?

At the EPOMEC 2023 meeting in Dubai, I had the pleasure of being on a speakers panel with Prof Fathy … More

2047: small pupil, shallow AC, delicate iris

This is a tough case in a patient with prior synechiae, a small pupil, a shallow anterior chamber, and a … More

2021: IOL gets entangled with pupil ring

Using a pupil expansion ring, like the Malyugin ring, can be helpful in some cases of a small pupil, but … More

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