This patient was born with a lens coloboma where part of the crystalline lens did not develop and there is … More
Category: unusual cases
1049: four flanged IOL suture fixation
We have seen a lot of innovation with regards to IOL fixation to the sclera. There is the Yamane technique … More
1046: fixing anterior capsule fibrosis
Our usual way of dealing with fibrosis of the anterior lens capsule is to use a sharp instrument such as … More
1045: suturing the IOL to the CTR
Our guest surgeon is Dr. Val Apostolov from Amsterdam and he demonstrates a technique that I have never seen before: … More
1043: intra-vitreal injection punctures lens
The most commonly performed ocular invasive procedure performed in the USA is the intra-vitreal injection, with many millions done per … More
1025: Soemmering’s Ring Extraction
Our guest surgeon, Dr Val Apostolov from Amsterdam, is a frequent contributor to CataractCoach and today he shows us a … More
1024: SICS for uveitic cataracts
This is a case of a cataract with extensive synechiae due to prior uveitis. The eye is quiescent now, with … More
1011: Opacified IOL Exchange
While it is rare, some IOLs can become opacified with time. This has been reported primarily with hydrophilic acrylic materials … More
considerations for monocular patients
Monocular patients present a special situation that can differ from a routine case in a patient with two eyes. We … More
Anterior Chamber Phakic IOL removal
Phakic IOLs are useful to address extreme degrees of myopia, but there are potential complications. Previously, we have featured cases … 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
Four handed phaco! What?
This is a case where we knew ahead of time there would be issues. The patient is mid 50s in … More
Cataract, cornea transplant, glaucoma tube
Our guest surgeon is Guillermo Amescua MD who is a faculty member at the Bascom Palmer Eye Institute in Miami. … More
Playlist: toughest cases of 2020
After reviewing the surgical cases from 2020, I have chosen four tough cases to present here. Two of the cases … More
chandelier lighting for cataract surgery
This patient has a non-clearing vitreous hemorrhage from proliferative diabetic retinopathy in addition to a cortical cataract. Our guest surgeon … More
anterior segment total reconstruction
This is a very complex case of a patient who had cataract surgery elsewhere and sustained complications during the procedure. … More
Patient moving during cataract surgery
Many patients ask us what will happen if they move during cataract surgery. What if they need to sneeze or … More
Fixing IOL-induced UGH Syndrome
UGH syndrome is the triad of uveitis, glaucoma, and hyphema which all can be induced as a complication from sulcus … More
Finishing this case will be difficult
The reason why ophthalmologists need to perform at least 1,000 cataract surgeries until they are sufficiently up the learning curve, … More
Pars Plana Injection of BSS
Our guest surgeon, Dr Mohammad Abusamak from Jordan, is performing cataract surgery on this monocular patient who has a high … More
Cataract Quiz: What should you do?
What are these dark spots seen in the red reflex as you are about to start cataract surgery? What do … 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
Cataract Surgery with prior Amblyopia
The most common causes of amblyopia are related to either strabismus or an untreated refractive error, particularly in one eye … More
Surprise! Loose Zonular Support!
This patient has a dense cataract and a surprise waiting for the surgeon: as the nucleus is being cracked, we … More
Cataract surgery & decentered LASIK flap
We frequently have patients with a history of prior LASIK who are now undergoing cataract surgery. We have explained in … More
scleral tunnel phaco incisions
Many years ago, incisions for cataract surgery were made in the sclera, even for the small phaco incisions. The scleral … 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
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
Complete Case: Pressurized Cataract
This is an interesting case of a young patient, in his mid 40s, who sustained ocular trauma and developed a … 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
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
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
Fixing severe capsular phimosis
In a small number of patients, capsular phimosis can happen after cataract surgery. This can lead to severe distortion of … More
Cataract Surgery in Silicone Oil Eyes
Retina surgeons will occasionally use silicone oil to help keep the retina in position during healing and in rare cases, … More
Bilateral brunescent cataract surgery
This patient has been functionally blind for 10 years and presents to us with bilateral, dense, brunescent cataracts. We must … More
Should you do surgery for this patient?
This is a complex patient who has many systemic medical issues and because her lab tests from this morning showed … More
From routine case to disaster in 1 second
When I first saw this video, which was submitted by an anonymous surgeon, I was in disbelief. I simply could … More
Cataract Surgery in MegaloCornea
This patient has a huge cornea with a diameter of about 14 mm and an equally large anterior segment including … More
Should you use a trifocal IOL in Fuchs’?
This is an unusual case: the patient has Fuchs’ Corneal Dystrophy and yet we are implanting a trifocal IOL. Usually, … 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
Expulsive Choroidal Hemorrhage!
This video is a MUST SEE! An expulsive choroidal hemorrhage is a rare complication than any cataract surgeon must be … More
Congenital Iris Coloboma Repair
We have another video from master surgeon Dr. Valentin I. Apostolov from Amsterdam. In this video he shows us his … More
Pupillary Cerclage Technique
In cases of chronic traumatic mydriasis, we can use sutures to reconstruct a pupil of a reasonable diameter. We have … More
Cataract Surgery with Asteroid Hyalosis
Asteroid hyalosis is a rare condition where patients have calcifications throughout the vitreous jelly. It occurs in about 1-2% of … More
Scleral-sutured IOL with GoreTex
This is an unusual case of prior trauma. A 13 year old boy was playing with fireworks and sustained a … More
Leukocoria in a newborn baby
Leukocoria in a newborn baby is an urgent situation that needs immediate attention from an ophthalmologist. The cause of the … More
How to Evacuate this Hyphema
This patient was struck in the eye with a Champagne cork, which was traveling at a high velocity and hit … 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
Why implant a zero power IOL?
This patient is ultra-myopic with an axial length of more than 31 mm. Using the free calculator at IOLcalc.com we … 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
Traumatic Cataract with Mydriasis: Part 2 Pupilloplasty
This patient suffered severe trauma as the result of an airbag injury from a car accident about one year ago. … More
Traumatic Cataract with Mydriasis: Part 1 cataract surgery
This patient suffered severe trauma as the result of an airbag injury from a car accident about one year ago. … More
Severe Capsular Phimosis
Capsular phimosis occurs when there is severe contraction of the anterior capsular tissue which results in a shrinking of the … More
Artificial Iris Implants
Kevin M. Miller MD is a world-renowned cataract surgeon at UCLA’s Jules Stein Eye Institute and he was an instrumental … 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
Cataract Surgery after Corneal Transplant
Cataract surgery in an eye with a prior corneal transplant is more difficult and there are challenges which can alter … More
Cataract Surgery & Lattice Corneal Dystrophy
Today we have a guest surgeon, Dr Carlos Yuji Nunomura from Brazil, who is demonstrating cataract surgery in an eye … 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
Cataract surgery in Nanophthalmos
Nanophthalmic eyes are very small with a short axial length of less than 20 mm. This makes the cataract surgery … More
Review: Cataract Surgery in Deep Set Eyes
Performing intra-ocular surgery in a deep set eye is challenging because the access is limited. In the case shown here, … More
Where did the hemi-nucleus go?
This video was submitted by Dr Ravi Prasad Challa from India and it showcases a very rare complication: a break … 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
Solving a tough case of Hexagonal Keratotomy
Featuring guest surgeon: Arun Gulani MD from Jacksonville, Florida, USA This complex case involved a patient who underwent hexagonal keratotomy … More
Evaluating Radial Keratotomy for Cataract Surgery
Radial keratotomy (RK) is an out-dated kerato-refractive surgery where radial incisions were made in the cornea in order to cause … More
Descemet Membrane Endothelial Keratoplasty
The skills learned from cataract surgery, such as working within the anterior chamber and pivoting within the incisions, can be … More
Capsular Tension Rings in Cataract Surgery
Capsular tension rings are flexible plastic loops which are designed to exert outward force at the capsular bag equator to … More
Options for IOL Explant: Twist or Cut
In rare cases, we may need to explant the IOL and replace it with a different IOL for a different … More
Quiz: What is this white material floating around?
Quiz time: What is this white material as seen in this aphakic eye? The 75 year old patient was noted … More
Quiz: Cataract Surgery in Fuchs’ Corneal Dystrophy
Look carefully at the picture and tell me what you would do differently for this cataract surgery. This patient has … More
The Most Extreme Myopia that I’ve seen in 20+ years
An average eye has an axial length of about 23 to 24 mm, but this patient had an axial length … 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
Surgical Peripheral Iridotomy using 23g Vitrector
There are times when you will need to make a surgical iridotomy either during cataract surgery or as a stand-alone … More
Small Pupil, Dense Cataract, Corneal Scar, Glaucoma
The key to approaching a difficult surgery is to use a stepwise approach. In the case presented here, we have … More
Bleeding in the Anterior Chamber during surgery
It is unusual to encounter bleeding in the anterior chamber during cataract surgery, but rarely it does happen. The typical … More
Quiz: Why does the IOL optic look cloudy?
This patient had cataract surgery with the same IOL about 18 years ago and she did very well for many … More
Cataract Surgery after Prior Uveitis Issues
Doing cataract surgery in an eye with a prior history of uveitis can be more challenging than a typical case. … More
Cataract Surgery in Pigment Dispersion Syndrome
Cataract surgery in patients with Pigment Dispersion Syndrome can be challenging due to the anatomic changes which have happened over … More
Should we do bilateral same-day cataract surgery?
On rare occasions, I will do immediate, bilateral sequential cataract surgery so that a patient can have both right eye … More
Cataract Surgery in Deep Set Eyes
Performing intra-ocular surgery in a deep set eye is challenging because the access is limited. In the case shown here, … More
Treating Iris Bleeding during Cataract Surgery
Typically, modern day phacoemsulification cataract surgery is relatively bloodless because we are making incisions in the cornea and then operating … More
Hidden Nuclear Fragment during Cataract Surgery
When we break up the cataract during phaco surgery, we create many small little pieces which are then aspirated from … More
Ocular Albinism Cataract Surgery
Ocular albinism poses a number of challenges for cataract surgery. The patient often has concomitant nystagmus, underlying amblyopia, macular issues, … More
Cataract Surgery in Retinitis Pigmentosa
While retinitis pigmentosa is considered a rare disease, it occurs with enough frequency that every cataract surgeon will encounter it … More
Soft Posterior Polar Cataract Technique
This is a patient with a history of high hyperopia (+7.5 of hyperopia) and posterior polar cataracts since childhood. The … More
Cataract Surgery with Traumatic Zonular Loss
Are you ready for a challenge? This patient is a relatively young construction worker who sustained a blunt traumatic ocular … More
Cataract Surgery with Glaucoma Shunts
Los Angeles is an amazing city which is very diverse and when I am teaching the UCLA ophthalmology residents, we … More
Removal of a Posterior Capsule Plaque
When we remove the cataractous lens there is sometimes a posterior plaque that is adherent to the capsule. How do … More
Surgical Approach for a Morgagnian Cataract
With a white cataract, typically the cortical layers opacify and may partially liquify, and that can make the surgery more … More
Cataract Surgery after Prior Vitrectomy
Cataract surgery in an eye which has undergone a prior pars plana vitrectomy is different in many ways, including lens … More
Cataract Surgery in Marfan Syndrome
Patients with Marfan Syndrome have a congenital, progressive weakness in the zonular structures which support the crystalline lens. As such, … More
Preventing and Treating Capsular Phimosis
The capsular bag contracts when we remove the thick cataract (4+ mm thick) and replace it with a thin IOL … More
Salzmann Nodules and Cataract Surgery
Salzmann nodules occur at the limbus or peripheral cornea and can disrupt the ocular surface, even causing an irregular ocular … More
Quiz: Persistent Corneal Edema – Why?
This 70 year old patient had successful cataract surgery about one month ago. There were no complications. The patient has … More
Efficient Cataract Surgery for Spastic Patient
Rushing during surgery, especially cataract surgery, is a bad decision. It can lead to complications which can cause a poor … More
Cataract Surgery in Fuchs’ Corneal Dystrophy
Fuchs’ endothelial dystrophy is a disorder in which the corneal endothelium becomes progressively weak, leading to corneal decompensation and decreased … 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
Why is phaco chop not working here?
This patient certainly needs cataract surgery because the dense nucleus has a large degree of central opacity and that has … More
A Cataract is not always what it seems…
Since we’ve spent so many years studying ophthalmology, the subtleties of our field become second nature to us. We can … More
Nevus of Ota Cataract Surgery
Nevus of Ota refers to hyperpigmented lesions on the sclera as well as peri-ocular skin. The color tends to … More