1176: cataract surgery in Fuchs’ dystrophy

You will certainly encounter patients with Fuchs’ dystrophy where the corneal endothelial cell layer becomes compromised. With loss of endothelial … More

1171: pigment dispersion syndrome

Pigment dispersion syndrome is a condition where iris pigment is dispersed throughout the anterior segment of the eye via the … More

1163: phaco behind the corneal scar

When a corneal scar limits the visualization, how can you still complete the cataract surgery in a safe manner? And … More

1151: white cataract and uveitis synechiae

This patient has a long standing history of uveitis which has resulted in synechiae between the iris and the anterior … More

1144: white cataract intra-capsular surgery

Decades ago the standard cataract surgery was an intra-capsular cataract extraction. This involved making a large incision, injecting alpha chymotrypsin … More

1141: white cataract with coloboma

This patient has a lens coloboma with about three clock hours of missing zonular support. This can make the surgery … More

1138: my 100 year old cataract patient

This patient is 100 years old and she now has decided that she would like cataract surgery. Certainly we are … 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

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

1101: Infant Lensectomy Technique

While congenital cataracts are rare, they must be identified very early in an infant’s life and then often surgically treated. … More

1100: Very soft PSC cataract technique

This patient is young, under age 40, and has been suffering from posterior subcapsular cataracts for more than 1 year. … More

1091: Dense Cataract and Nystagmus

Our guest surgeon is Dr Érico Jun Oda from Brazil and he demonstrates an expert level cataract surgery in a … More

1077: traumatic cataract & pupilloplasty

This patient sustained blunt trauma to his eye and then developed chronic mydriasis and a cataract with significant zonular loss. … More

1068: sutured capsular tension segment

This patient was born with a lens coloboma where part of the crystalline lens did not develop and there is … More

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

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

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

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

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

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

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 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