1172: anterior capsular tear in phaco

The lens capsular bag is fragile and very thin, with an anterior measurement of about 14 microns and a posterior … More

1168: rescue this descemet’s detachment

Descemet’s membrane is very delicate and it can become detached during surgery. The usual entry site is from one of … More

1149: posterior capsulorhexis technique

There are times when it is helpful to perform a posterior capsulorhexis. This is a tricky maneuver because it opens … More

1137: too soft to chop, so tumble it

If you know a variety of different phaco techniques, it is easy to switch gears and shift to something that … More

1136: Refractive Lens Exchange Surgery

For high degrees of hyperopia in presbyopic patients, the best surgical solution is refractive lens exchange. For a younger patient, … More

1131: Cataract Surgery in Ocular Albinism

Ocular albinism is rare, however just about every cataract surgeon will encounter at least one or two patients with this … More

1128: Why can’t I get the nuclear piece up?

You are ready for action. You embed the phaco probe and achieve high vacuum. You carefully place the chopper into … More

1124: Pearls for learning MSICS

It may surprise you to know that many young ophthalmologists in the USA do not have experience performing MSICS. In … More

1114: success with young cataract patients

When we are operating on a younger cataract patients, the stakes are higher and the surgery must last the patient … More

1112: surgical pearls for ocular asymmetry

While most patients have eyes that are very similar, there are a few patients where the eyes are remarkably different, … More

1099: some amazing surgical pearls

With CataractCoach, I am sharing everything that I have learned or figured out during the past 25 years in ophthalmology. … More

1095: Where to place the chopper

Let’s admit that phaco chop can be a tough technique to learn. It requires both hands to perform a different … More

1089: Try the CataractCoach Challenge

Take the CataractCoach challenge: perform a cataract surgery while keeping the light reflex (Purkinje image) in the central zone of … More

1080: phaco tip punctures the capsule

This anonymously submitted video shows a complication that can happen to any of us. This patient had a white cataract … More

1074: Angle sweep at the end of phaco

While we need viscoelastic to perform a safe cataract surgery, we do not typically want to leave this OVD inside … More

1073: Why did the AC Depth increase?

This patient had biometry performed in our clinic, using the same machine in 2017 and then again in 2021. Of … More

1036: How to prepare Triamcinolone

Triamcinolone is a longer-acting steroid that is very useful for intra-ocular surgery. We can use it to modulate inflammation, to … More

1004: Preventing Capsular Rip in white cataracts

This 30 year old patient has a tough situation: bilateral white cataracts with high pressure within the capsular bag. There … More

Cataract with Silicone Oil Removal

Our guest surgeon is Willie Kan, MBBS from Malaysia and he is showing the technique of combined cataract surgery with … More

Simplified Pre-Chop Technique

The pre-chop technique refers to mechanically breaking the nucleus into smaller pieces prior to inserting the phaco probe into the … More

The critical step after the chop

There is a critical step after the chop that is absolutely required to facilitate nucleus removal. And this step is … More

clean your optics & focus the microscope

This is actually a very important lesson. Your microscope optics will determine your view for the surgery and that could … More

double flange IOL scleral fixation

The Yamane technique of IOL fixation to the scleral works better with certain three-piece IOLs because of the differences in … More

This subtle sign indicates weak zonules!

This is a very subtle sign — looking at this title pic, we see a demarcation line just inside the … More

This sign means I need a pupil ring

this sign means that I need a pupil ring for cataract surgery

Secret to Chopping a Soft Cataract

If the cataract has a minimal amount of nuclear sclerosis, it is more challenging to chop it. The nucleus is … More

Cataract Quiz: Why did this happen?

Looking at this picture, the pupil dilation went from 5 mm in diameter to 10 mm in diameter in just … More

Rock the Nucleus in White Cataracts

The topic of white cataracts is so popular here on CataractCoach that we have an entire category devoted to it … More

Complete Case: Propagate the Chop

Another video in our Complete Cataract Case series where we show you an entire surgery from start to finish. 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

the bowled out nucleus

We have all experienced it: a nucleus that it too soft and gummy to divide in the capsular bag and … More

Amazing Pterygium Peeling Technique

After more than 20 years of doing ocular surgery, there are only a few surgical pearls that amaze and surprise … More

Not all white cataracts are the same

All white cataracts are not the same. They can run the spectrum from soft to very dense, with a variable … More

Keep track of cortex during surgery

Even with good dilation, cortex can be hidden at the capsular bag equator. In this case, the dilation is about … More

compilation video: perfecting your surgery

The difference between good and great may appear subtle to outsiders, but for ophthalmologists like us, these details are very … 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

Corneal Phaco Incision Hydration

The technique of corneal stromal hydration to help seal a phaco incision is useful to ensure a watertight incision and … More

easily aspirating the epi-nucleus

It is much faster and easier to aspirate the epi-nucleus using the phaco probe than the I/A probe because the … More

cannula for cortex aspiration

Bimanual irrigation/aspiration for cortex removal has an advantage: it is easy to switch hands and then access a full 360 … More

measure the capsulorhexis in high myopia

Eyes come in a spectrum of sizes, particularly with the measurements of the anterior segment in patients with extreme refractive … More

Cataract Quiz: slight peak of pupil

This is a very subtle sign — look carefully at the picture. In the sub-incisional area, there is a slight … More

Glaucoma Drainage Implant Technique

I have learned so much from the video submissions that we receive at CataractCoach. It makes me wonder how I … 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

Peeling Capsular Membranes

We present another great learning video from Dr. Val Apostolov from Amsterdam, The Netherlands to show the techniques of peeling … More

Setting your Phaco Speed Limit

The speed at which surgery happens during phaco is directly related to the aspiration flow rate, which is measured in … More

the hemi-nucleus tuck technique

One of the challenges in phaco surgery is that we need to break up the nucleus in order to remove … More

Draining a choroidal hemorrhage

We recently featured a video of a sudden choroidal hemorrhage which happened during implantation of an IOL. This is a … More

Spiral Capsulorhexis Technique

After needle decompression of the cataract, using a spiral technique for the capsulorhexis has a distinct advantage: if there is … More

White cataract needle decompression

We know that an intumescent white cataract is fluid-filled with liquefied lens cortex. This makes the pressure within the capsular … More

Wrinkled and fibrotic lens capsule

This seemed like a typical white cataract during the pre-operative exam and when first placed under the surgical microscope on … More

Review: Surgical Peripheral Iridotomy

here are times when you will need to make a surgical iridotomy either during cataract surgery or as a stand-alone … More

Small incision glaucoma surgery

This video is amazing — when I first saw this technique, I was in awe because I learned so much. … More

The Subtleties of Cataract Surgery

The difference between good cataract surgery and great cataract surgery comes down to subtleties. There are very slight nuances to … 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

Enlarge the Capsulorhexis

A small capsulorhexis makes nucleus removal more difficult, especially when we have a dense cataract. When the entire lens hardens … More

Staying calm when you see danger signs

The second that I see this round hole, I know that it is a danger sign. We have previously explained … More

Fixate the eye with your other hand

The problem with using two hands to hold the capsulorhexis forceps is that you lose the ability to have the … More

Examine instruments before using them

We must examine our instruments before using them to ensure that they are intact and in normal, working condition. In … More

DMEK surgery with pre-loaded graft

We have previously featured Descemet Membrane Endothelial Keratoplasty here on CataractCoach with a video from one of my residents and … More

Seems like a good chop but…

Another video for our series of Complete Cataract Cases, we present a surgery of me operating. During this surgery, I … More

Predicting Pseudo-Exfoliation weakeness

We have previously covered the topic of pseudo-exfoliation (PXF) in detail here on CataractCoach. It is an important topic because … More

Ensuring accuracy of A-scan ultrasound

Correlate A-scan & biometry measurements to improve accuracy in IOL calculations. This case shows how disparate measurements can lead to … 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

Do not withdraw infusion with a capsule break

If there is a break in the posterior capsule, withdrawing the infusion will allow the anterior chamber pressure go to … More

What are these lines? What is Reflux?

These lines are the posterior capsule which has found its way into the suction port of the I/A probe. We … More

Fix this Iris Prolapse in 2 seconds

Really. This is not an exaggeration. If you understand the physics of why the iris is prolapsing through the incision, … More

Cortical Cataracts can cause “white-out”

Cortical cataracts occur when some of the lens material becomes liquefied, thereby blocking the visual axis. When we perform hydro-dissection … More

Phaco Chop in patients over age 90

In previous videos we have explained the differences when operating on nonagenarian patients. These patients have weaker tissues such as … More

The surgeon will struggle to finish. Why?

In this resident surgeon case, the anterior chamber flattens and there is loss of viscoelastic upon attempted manipulation of the … More

The Smallest Permissible Capsulorhexis

From watching our videos, you know that for most cases, I find that a 5 mm capsulorhexis is ideal. This … More

Peeling off a Pupillary Membrane

In this complex case, there is a nearly complete pupillary membrane in an eye with a cataract and a prior … More

Complete Case: Dense PSC & Shallow AC

This is a complete case, shown from start to finish. For many of our CataractCoach viewers, particularly the surgeons with … More

Checking the IOP at the end of surgery

We want to ensure an appropriate intra-ocular pressure (IOP) at the end of surgery. This puts the eye in a … More

The trick to bring cataract pieces to the phaco tip

This is one of my favorite tricks to teach residents: when there is a nuclear piece of cataract in the … 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

Quick Fix for Reverse Pupillary Block

In myopic eyes and post-vitrectomy eyes, we can get an overly deep anterior chamber during cataract surgery. The infusion pressure … More

What can we learn from the first eye cataract surgery?

The patient had cataract surgery of the right eye two years ago. Initially, she had a plano outcome and great … More

Review: Surgical Peripheral Iridotomy

There are times when you will need to make a surgical iridotomy either during cataract surgery or as a stand-alone … More

Re-draping the eye makes surgery more efficient

When we place the drapes on the eye and eyelids, it serves to give us better exposure of the surgical … More

It takes new surgeons years to figure this out

This is such a great lesson, that I’m going to limit the text here. Watch the video and learn something … 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

Capsulorhexis with an anterior capsular plaque

This anterior capsular plaque makes the capsulorhexis creation more challenging. The capsule will not tear predictably in the region of … More

Cataract Surgery in a 100-year-old patient

We should all be so lucky to live to 100 years old. It’s quite a rarity and it is something … 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