In most cataract surgery cases, the femtosecond laser does not offer any advantage over a proper capsulorhexis performed by an … More
Category: zonulopathy
2432: fix zonular loss with CTS + Goretex
This is a tough case of a traumatic cataract with about half of the zonular support being compromised (6+ clock … More
2429: MSICS for PXF with zonular loss
This patient has severe pseudo-exfoliation and you can tell from the pre-operative photo that there will be extensive zonulopathy. The … More
2328: saving the capsular bag in ectopia lentis
This patient has ectopia lentis with severe subluxation of the crystalline lens. Our guest surgeon does a great job of … More
2321: ectopia lentis from homocystinuria
There are certain rare diseases, such as Marfan syndrome and homocystinuria, which lead to progressive zonulopathy with subluxation of the … More
2310: fluid misdirection from zonulopathy
Compared to methods of manual cataract extraction, phacoemulsification offers so many benefits such as a smaller incision, a higher margin … More
2256: Quiz: Where is the red reflex?
Time for another Cataract Quiz: You are doing phaco for this patient with a traumatic white cataract and everything seems … More
2255: zonular loss noted during phaco
You are performing phaco chop for this patient with a white cataract and as you start to remove a nuclear … More
2248: the challenge of iris colobomas
When we see an iris coloboma, we should also think of other ocular structures that can be affected by this … More
2233: you start to chop & the rhexis moves
Yesterday’s informative CataractCoach podcast featured Dr Gary Wörtz and we spoke about a challenging case that he recently completed. This … More
2224: using 10 capsular/iris hooks!
This patient has severe pseudo-exfoliation with almost zero capsular support. When the surgeon attempts to start the capsulorhexis, the entire … More
2207: cataract surgery with coloboma
In this tough case the patient has a visually significant cataract but also a congenital coloboma which you can see … More
2193: Best of Cataract Coach: Case 7
Case 7. We had an amazing turnout at our Best of Cataract Coach instructional course at the ASCRS meeting in … More
2188: Best of Cataract Coach: Case 3
Case 3. We had an amazing turnout at our Best of Cataract Coach instructional course at the ASCRS meeting in … More
2178: Morgagnian cataract & IOL scaffold
A Morgagnian cataract is where the lens cortex is so liquefied that the remaining cataract endonucleus floats around inside the … More
2167: Hashtag suture to stabilize the IOL
This young patient has Marfan Syndrome and previously underwent pars plana vitrectomy and lensectomy for a dislocated crystalline lens with … More
2165: zonular loss and iris prolapse
Every surgeon encounters complications and often times these are out of the control of the surgeon. Imagine a patient who … More
2158: How to fix this traumatic cataract?
You cannot fully undo trauma, especially when it comes to the eye and delicate ocular structures. This patient sustained ocular … More
2157: What is going on with that CTR?
Inserting a capsular tension ring (CTR) is not as simple as it sounds. This ring has a spring tension to … More
2136: secure the IOL, CTR, and bag complex
This patient has a history of prior cataract surgery with CTR placement and pseudo-exfoliation glaucoma. You can see an active … More
2132: how to manage a floppy old bag
Once the capsulorhexis is started, it is clear that this patient has severe zonulopathy. The wrinkling of the anterior lens … More
2115: Quiz: What happened with the CTR?
Look carefully at the title photo and let me know what you think is going on with the CTR? What … More
2112: severe anterior capsule phimosis
This patient has severe capsular phimosis which happens where there is weak zonular support and aggressive contraction and fibrosis of … More
2083: Quiz: how to manage zonular dialysis?
Look at the picture here and you will see a red reflex indicating a quadrant (or more) of zonular laxity … More
2082: traumatic cataract CTR placement
Our guest surgeon presents a case of a traumatic cataract with zonulopathy. A capsular tension ring is implanted prior to … More
2077: what is an intra-cap cataract surgery?
I received a couple of emails from young surgeons asking to explain the difference between intra-cap, extra-cap, and MSICS cataract … More
2044: re-op of tough pseudo-exfoliation
Pseudoexfoliation affects only a small percent of patients undergoing cataract surgery, but it is important to recognize because it poses … More
2040: Ahmed segment secured with Gore-tex
This patient presents with a traumatic cataract with extensive zonular loss which means that simply placing an IOL within the … More
2032: ectopia lentis with suture fixation
This is a tough case of ectopia lentis where there is absent zonular support for most of the lens equator. … More
2019: dislocated IOL, CTR, capsular bag
This patient had cataract surgery years ago and then progressive zonulopathy, such as from pseudo-exfoliation, caused the entire capsular bag … More
2018: dislocated IOL replaced with ACIOL
Looking at this title pic, you can see a large degree of capsular phimosis. This progressive constriction of the capsulorhexis … More
2012: Gore-tex suture fixation of tilted IOL
This patient was pseudophakic and then sustained ocular trauma which resulted in zonular loss and a tilting of the IOL … More
2011: Quiz: What is the zonular status?
Time for a Cataract Quiz: Look carefully at this title photo and ask yourself, “Why is this clear crescent visible … More
2006: Marfan Syndrome lens dislocation
We have previously featured videos of cataract surgery in patients with Marfan Syndrome, where there is progressive zonulopathy that results … More
2005: pseudo-exfoliation triple surgery
This is a VERY difficult surgery and truly requires expert hands to achieve an excellent outcome. Our guest surgeon does … More
1992: trypan blue behind the capsule
Trypan blue dye can go behind the capsule and stain the vitreous, pool in front of the anterior hyaloid face … More
1991: zonular weakness during capsulorhexis
Look at the photo here and you just know that the zonular support is globally weak. There are radial wrinkles … More
1989: anterior zonular attachment
This is a very rare case which I have seen in less than 1 out of 1000 cataract surgeries. This … More
1983: trauma, hyphema, & iris damage
We know that you cannot undo trauma. No matter how talented the surgeon and no matter the part of the … More
1967: behind the scenes traumatic cataract
Our podcast guest yesterday was Dr Brandon Ayres from the Wills Eye Hospital in Philadelphia, USA and explained his stepwise … More
1963: inadvertent zonular dehiscence
Iatrogenic complications are tough because we blame ourselves for the sequelae of damaging delicate tissues. In this photo you can … More
1935: Cataract Quiz: What is your next move?
Study this title picture carefully and look at the tip of the yellow arrow. What is going on here? And … More
1909: zonulopathy with capsule fixation
This patient has extensive zonulopathy and phacodonesis which is going to make the cataract surgery difficult and also pose a … More
1905: Cataract Quiz: What does this tell you?
Stop reading and look carefully at the title picture here. What does this tell you? Seriously, stop reading and study … More
1859: MSICS with iris & lens coloboma
This is a tough case of a dense cataract in a patient with an iris and lens coloboma. This means … More
1842: ASCRS 2023 Course Case 2
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
1810: severe zonular loss with Cionni ring
Cases like this are stressful and just looking at this picture should make your heart beat faster. There is a … More
1799: posterior polar with zonular loss
We know that posterior polar cataract cases are challenging because at the site of the opacity the posterior capsule is … More
1787: tilted nucleus with severe zonular loss
This lens is so loose that it is shaking around inside the eye – a severe case of phacodonesis. This … More