Presbyopic IOLs, primarily trifocal designs, can make patients very happy. However there are some important considerations in order to achieve … More
Category: surgical pearls
1824: two jerky pulls to save the capsulorhexis
We have previously covered the Little Technique to pull backwards to help save a run-out capsulorhexis. This Two Jerky Pulls … More
1818: My Week: Sub-incisional cortex
With sub-incisional cortex, using a bimanual IA set-up makes it relatively easy to remove. However, with a co-axial IA probe, … 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
1816: My Week: flush out nuclear chips
Every single cataract surgeon who has done at least a few thousand cases has encountered a case with a retained … More
1734: the 7L rule saves the day
The 7L rule has been passed down from one generation of ophthalmologists to the next for many decades. It is … More
1709: save this run out capsulorhexis
This guest surgeon does a great job of managing this run out capsulorhexis. It extends all the way to the … 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
1685: Primer on how to perform LASIK
Best pearls for learning to perform LASIK
1682: what is your approach to chemosis?
Chemosis. It happens to all of us. Just a slight cut of the conjunctiva and the balanced salt solution will … 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
1649: phaco wound burns
This video is critically important, especially for younger surgeons, because a phaco wound burn is a complication that happens more … 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
1628: more pearls for highly myopic patients
Highly myopic patients are amazed by cataract surgery because we can address even extreme degrees of myopia while giving great … More
1625: aqueous fluid misdirection syndrome
This is my video from the Cataract Spotlight session by Dr David Chang from the American Academy of Ophthalmology 2022 … More
1620: pseudo-exfoliation cataract surgery
When it comes to patients with pseudo-exfoliation (PXF) and cataracts, does the pre-operative examination predict the intra-operative challenges? The title … More
1613: Yamane-Kim intra-scleral fixation
Our guest surgeon does a beautiful job of performing the Yamane intra-scleral fixation technique and he takes it one step … More
1593: this EDOF patient will be amazed
What are the factors for success with EDOF (extended depth of focus) IOLs? How can we ensure that the patient … More
1592: off-axis incisions and toric IOLs
Your surgically induced astigmatism (SIA) from your standard phaco incision is probably far less predictable than you think. There are … 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
1486: LIDRS to help with cortex removal
LIDRS is Lens-Iris Diaphragm Retropulsion Syndrome and it occurs where there is a reverse pupillary block and the pressure in … More
1485: how I know zonular support is weak
Weak zonular support makes cataract surgery far more challenging and increases the potential risks such as vitreous prolapse, retained lens … More
1484: phaco before vitrectomy surgery
This patient has visually significant cataracts in both eyes and a full-thickness macular hole in one eye. I have already … More
1481: ASCRS case 12: phaco in trab eyes
This is our last of the dozen cases presented at the CataractCoach instructional course at the 2022 ASCRS meeting. When … More
1478: ASCRS case 9: upside down IOL
You may be surprised to learn that an upside down IOL happens to every single cataract surgeon. The key is … More
1472: ASCRS case 3: rock the nucleus
Rocking the nucleus is an important step for intumescent white cataracts because it allows the liquefied cortex that is behind … More
1455: cortex removal before nucleus removal
This video shows something that I have never previously seen before: removal of the lens cortex prior to removing three … 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
1452: always give the benefit of the doubt
This is one of the most critically important lessons in ophthalmic surgery. You must remember that the result of surgery … More
1444: the patient moved during the rhexis
As I am performing the capsulorhexis, the patient unexpectedly moved and there is a run-out of the capsule tear. The … More
1443: the nucleus just will not rotate
This is a seemingly routine case, shown start to finish, where I find it challenging to rotate the nucleus despite … More
1439: save this case of capsule rupture
Our guest ophthalmologist is Dr Cathy McCabe from Florida, USA and she is truly a master surgeon, having done tens … More
1438: intra-lenticular foreign body
Our guest surgeon is Asst. Prof. Christina Mamalis MD from the University of Texas in Houston, and she presents a … More
1432: high myopia refractive targeting
There is a reason why I recommend that you do NOT aim for a plano outcome in highly myopic eyes. … More
1431: this is why I just need one chop
For routine cataract cases, I can perform just one phaco chop to split the nucleus into two halves and then … More
1429: refractive lens exchange pearls
In my quest to give away every secret, surgical pearl, and useful bit of knowledge that I have acquired over … More
1419: How to reposition a toric IOL
It is now months after the original cataract surgery and you examine your patient and realize that the toric IOL … More
1411: how much capsule polishing to do?
Capsule polishing to remove tiny residual bits of lens material is frequently done in cataract surgery. We have asked our … 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
1400: handling the run-out capsulorhexis
The capsulorhexis has a tendency to run-out if the anterior lens capsule is insufficiently flattened, if there is any posterior … More
1384: four short videos with great pearls
Today we present four short videos with great surgical pearls. I am sure that you will learn something new and … More
1372: my best pearl for Flomax/IFIS cases
This is a complete cataract case shown start to finish in a patient who has floppy iris syndrome due to … More
1358: sub-incisional cortex removal
In the USA, the most common method for removal of cortex is using a coaxial IA probe, whereas in other … More
1356: effective draping for cataract surgery
Watching amazing intra-ocular acrobatics during a challenging cataract case is exciting and makes for a great video, but those cases … 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
1349: share your best surgical pearl
We had some much needed rain in Los Angeles recently and I was fortunate to catch a beautiful rainbow. And … More
1341: phaco in a trabeculectomy eye
Anytime we perform cataract surgery in an eye with prior ocular surgery, there are additional challenges. In eyes with prior … More
1340: plan your rhexis to avoid opacities
Yesterday’s video (#1339) showed how to move cortical opacities from the path of the capsulorhexis by pushing the liquefied lens … More
1339: you can move cortical spokes
Cortical lens opacities tend to block the red reflex which can make capsulorhexis creation more difficult. Since these cortical spokes … More
1337: how to needle encapsulated setons
A glaucoma seton, such as the Ahmed Valve from New World Medical (by the way, it is not named or … More