The benefit of learning many different phaco techniques is that you can choose the one that is best for each…
Quiz: Cataract & Penetrating Corneal Injury
This patient had a penetrating corneal injury many years ago. When we look at the eye we can see evidence…
Learning Vertical Chop
Vertical chop means that both the phaco probe and the chopper are placed within the capsulorhexis and then both are…
Full List of All Videos by Category
Here is a complete list of all videos sorted by category. This list will be continuously updated as we post…
Slow Motion Phaco Chop
In the course of giving lectures across the USA and around the world, I meet many experienced ophthalmologists who find…
Methods of Capsule Polishing
For polishing of the undersurface of the anterior capsular rim, we can use a friction method with specialized instruments or…
Review: 1 or 2 hands for the capsulorhexis?
The capsulorhexis is one of the most important and most challenging steps of cataract surgery. When you are performing the…
Guest Surgeon Phaco Chop Technique
One of the hallmarks of a good surgeon is the ability to learn from other surgeons. In this case we…
Making a Scleral Tunnel Phaco Incision
For 99% of my patients, making a corneo-limbal phaco incision is ideal. However, there are cases such as this patient…
Quiz: What does this sign mean?
You are just about to start the capsulorhexis and you notice that the anterior lens capsule has straie emanating radially…
Initial Review of the Alcon PanOptix IOL
The Alcon PanOptix IOL has been available in the USA for about three months. What are our initial impressions? How…
Opacities seen during cataract surgery
In this unusual case we see opacities in the red reflex during cataract surgery. Most of these are within the…
Draping the Eye for Cataract Surgery
Draping the eye is important for cataract surgery. It helps us to create a sterile field and it isolates the…
Review: Check under the iris for lens material
When performing cataract surgery for an eye with a moderate or small pupil, be sure to check under the iris…
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…
Mastering Divide-and-Conquer Phaco
Back by popular demand! Most beginning surgeons start by learning divide-and-conquer as the primary method of nucleus division for cataract…
Quiz: Why is this phaco chop going to fail?
Look at this photo carefully. We can tell that this phaco chop will fail and the nucleus will not be…
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…
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…
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…
Review: Understanding Purkinje Images
Intra-ocular lens implants which are well-centered can provide better quality of vision for our cataract surgery patients. In the ideal…
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…
Phaco Chop in the bag with smaller pupils
In many of the prior videos related to smaller pupils, I have emphasized the technique of bringing the nucleus partially…
Quiz: What is happening in this eye?
Look carefully at this photo taken at the slit-lamp microscope. What is happening in this eye? Describe what you see…
Guest Surgeon “Submarine Chop”
We all learn from each other and today’s video is a great example of that. We are learning from Dr.…
Easy way to fix iris prolapse
We have all experienced it: the case is going well but then the iris starts to prolapse out of the…
Working near the corneal endothelium
We have to be very careful to protect the corneal endothelial cells, particularly in the center of the patient’s visual…
Review: Achieving the State of “Flow”
The psychological state of Flow is described as “energized focus, full involvement, and enjoyment” of the action being performed. Some call this…
Do you really want to learn surgery?
This is one of the most important videos that I have ever made. If you only watch one of my…
I am thankful for…
Today is Thanksgiving in the USA, which is a holiday in the USA when we give thanks to the people…
Quiz: Why is the vision 20/200?
This patient has a pre-op visual acuity of just 20/200 but the cataract does not look that bad. Also, we…
Evaluation of Tilt-and-Tumble Phaco
An anonymous surgeon has submitted a video of the tilt-and-tumble phaco technique which tends to work well with milder degrees…
Cataract Surgery prior to Glaucoma Surgery
We know that this patient will be undergoing glaucoma surgery in the near future and you are doing the cataract…
Left-Handed Phaco: What is different?
In this video we review the differences between right-handed phaco and left-handed phaco. As expected, the instruments are held differently,…
Review: Choosing Phaco Machine Settings
Surgeons often ask about which phaco settings are best. The answer is that it depends on the surgeon, the machine,…
I/A probe going under the cortex
Most of the time, we grab the cortex edge under the anterior capsular rim and then we strip centrally. But…
Cataract Surgery in Keratoconus
When a patient has keratoconus, what is different about the cataract surgery? Can you still make your phaco incision in…
Quiz: What is this focal lens opacity?
What is this focal lens opacity that is seen during cataract surgery? And how do we remove it? What likely…
Challenges with a smaller capsulorhexis
What are the challenges with a somewhat smaller capsulorhexis? In most of my cataract cases, I try to make a…
Three-Plane Phaco Incisions (Tri-Planar)
Making the phaco incision is one of the most critical steps in cataract surgery. A well-constructed incision will seal without…
Watch out for the tubing lines!
This is a simple, but important, lesson: keep the tubing lines and the phaco power cord away from your surgical…
Review: Learn Horizontal Phaco Chop
The original phaco chop technique described by Dr. Nagahara in 1995 was the horizontal chop. This involves holding the lens…
Expert Level Divide-and-Conquer
Many surgeons like the divide-and-conquer technique and it is widely used here in the USA. For young surgeons, it is…
Evaluation of a resident chop technique
This video was submitted by a resident in Asia who is still learning phaco and has upgraded to using the…
Does Capsulorhexis direction matter?
Does it matter which way you perform the capsulorhexis? Clockwise or counterclockwise, which is better? What about for right handed…
How to sculpt a nuclear groove
Sculpting a groove in the nucleus is required for techniques such as divide-and-conquer and stop-and-chop. The groove works best when…
How to do Limbal Relaxing Incisions
Just about any incision in the cornea will induce some astigmatic change. We have shown how to place the phaco…
Learning Surgical Pearls from Colleagues
There are all sorts of surgical pearls that we can learn from our colleagues. Different techniques and methods of making…
Review: How to Handle IOL Haptic Twist
When we inject a three-piece acrylic IOL into the eye, we must be very careful to ensure that the IOL…
Guest Surgeon: Phaco Chop Technique
This video was anonymously submitted by an experienced surgeon who wants us to analyze the phaco chop technique and give…
Resident Stop and Chop Cataract #50
After doing 50 cataract surgeries, most beginning surgeons have developed good technique for the steps of the procedure. For surgeons…
Quiz: what is different about this white cataract?
This patient has an intumescent white cataract but something is different about this case. In fact, there is a very…
Cataract surgery in Nanophthalmos
Nanophthalmic eyes are very small with a short axial length of less than 20 mm. This makes the cataract surgery…
Pre-Chopper Phaco Technique
There are many different ways to divide the nucleus during cataract surgery. Phaco of smaller nuclear fragments is easier and…
CTR Technique with less capsular stress
We have featured prior videos about insertion of capsular tension rings (CTRs) during cataract surgery. These devices can be very…
Review: Angle sweep to remove all OVD
When we fill the eye with viscoelastic, we push it with the greatest force into the opposite angle of the…
Cataract Surgery Draping is Critical
Watching amazing intra-ocular acrobatics during a challenging cataract case is exciting and makes for a great video, but those cases…
Close Up: Technique for Phaco Incision
We have shown many videos about the importance of the phaco incision. It is part of the signature that you…
Quiz: iris is prolapse & bleeding – now what?
Quiz time: This patient has floppy iris syndrome from tamsulosin use and you are experiencing iris prolapse during his cataract…
Capsulorhexis technique with just forceps
In more than 99% of my cataract surgery cases, I do not use a cystotome to start the capsulorhexis. I…
Surgeon Ergonomics for Ocular Surgery
As an ophthalmic surgeon, you will spend a large part of your future in the operating room performing delicate ocular…
When should we leave “good enough” alone?
When should we leave “good enough” alone? Ophthalmologists tend to be perfectionists in nature and I certainly fit that description.…
Review: An easy way to help seal the incision
If your phaco incision is properly constructed, it will typically seal quite well without the use of sutures. We can…
Sit temporal but operate using WTR incisions
With-the-rule (WTR) astigmatism is where the steep axis is at or near the 90 degree axis. Placing incisions on the…
Secrets to Avoid Corneal Edema after Cataract Surgery
Corneal edema can occur after cataract surgery due to a number of factors such as a higher degree of ultrasonic…
Quiz: What are these spots seen during surgery?
During cataract surgery for this patient, everything seemed relatively routine. The patient is elderly with some zonular laxity, but even…
Use the Chopper to Lift Nuclear Pieces Up
In cases where the capsulorhexis is small or where the nucleus is particularly large, it can be difficult to bring…
Learn the Pupil Stretch Technique
Stretching the pupil during cataract surgery is a safe and effective way to improve access via mechanical dilation. While there…
Analysis of a Divide-and-Conquer Cataract Case
This anonymously submitted video is from a surgeon who is 5 years into practice after the culmination of her training.…
Review: Embed the phaco probe without ultrasound
The classic teaching for phaco chop and quadrant removal is to embed the phaco probe into the nuclear piece by…
How to Save this Run-Out Capsulorhexis
This case is performed by a junior resident who has done about 20 cases so far. The trouble starts when…
Lysis of Synechiae and Capsule Staining under Iris
This patient had a prior episode of anterior segment inflammation which caused synechiae to develop, with adhesion of the iris…
Quiz: Why does this pupil look irregular?
This patient is undergoing a combined cataract surgery with a pars plana vitrectomy. Two novice surgeons are operating: a senior…
Combined Phaco + MIGS for cataract + glaucoma
Cataract surgery alone is a powerful technique for lowering intra-ocular pressure, particularly in patients with glaucoma. By replacing the 4+…
Combined Phaco + DMEK Surgery for Fuchs’ Dystrophy
This patient has a cataract as well as Fuch’s corneal dystrophy. Her pre-operative corneal pachymetry is almost 700 microns centrally…
What is the correct way to hold a fluid syringe?
When we have a syringe that is filled with liquid, be it balanced salt solution or visco-elastic, we have a…
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,…
Paired Phaco Incisions to Treat Astigmatism
Cataract surgery is our most powerful refractive procedure based on the spherical power that we can correct. Anything from –30…
Does Capsule Polishing prevent capsular opacity?
There has been much debate around the issue of polishing of the undersurface of the anterior capsular rim, yet there…
Resident Double Capsulorhexis for White Cataract
We know that intumescent white cataracts have a pressurized capsular bag with the milky white, liquefied cortex material. And we…
Guest Surgeon Efficient Divide-and-Conquer
After thousands of cases, surgeons become very efficient and can complete cataract procedures with fewer instruments and less surgical trauma.…
Two important danger signs in traumatic cataract
Guest surgeon and expert Ashraf Armia MD shows us two very important danger signs in a traumatic cataract case: wrinkles…
Surgical Approach to a Traumatic Cataract
When we are faced with a traumatic cataract, there are many factors to consider. The easiest issue is the lens…
Review: Phaco Incision OCT & Live Video Analysis
The phaco incision is part of your signature which links you to the patient’s eye forever. Your incision will forever be visible…
Why are we making a small capsulorhexis?
In many previous videos, we have explained why it is important to have a sufficiently large capsulorhexis. For an optic…
Linear marks seen during cortex removal
For surgeons with just a few years of experience, the part of cataract surgery where a posterior capsule break is…
Quiz: What is going on with this IOL haptic?
The surgery has gone very smoothly and the senior resident is doing a great job. The incisions are good, the…
Phaco Chop without using the phaco probe
This is a cataract surgery performed by a resident in training and the patient is known to have Fuchs’ corneal…
Achieving a complete hemi-nuclear split
When performing any nucleo-fractis technique, it is imperative that the nucleus be completely subdivided prior to removing the halves, quadrants,…
Resident surgeons must learn to load the IOL
The surgeon must know how to do every single part of the surgery, including setting up the phaco machine and…
Review: Cataract Surgery in Patients age 90+
Average life expectancy is at an all-time high in the US at 79, with even better news for people who…
Resident Surgeon takes on a Dense White Cataract
It is a pleasure to show you this video where one of my senior residents performs and excellent cataract surgery…
Slow motion analysis of posterior capsule rupture
Watching surgical video of cases is very helpful to understand the how and when of the complications of cataract surgery.…
Quiz: What is the huge danger seen in this photo?
This surgery is being performed by a senior resident and it starts off great. It is a dense white cataract…
Novice surgeon performs cataract surgery
This video was anonymously submitted by an ophthalmology trainee outside of the USA. He has completed about 90 cataract surgeries…
Analyzing a resident Stop-and-Chop case
Most of the uncut surgical videos that are shown here are very efficient and complete cases can be performed in…
Toric IOL with intra-operative aberrometer use
Guest Expert John Hovanesian MD implanting a Toric IOL with aberrometer guidance Dr. Hovanesian is a well-known and much respected…
Review: Temporal vs Superior Phaco Incisions
Some surgeons prefer to make a superior phaco incision while others prefer a temporal approach. Is there a substantial difference…
Advice for young ophthalmologists for future success
Today we celebrate our 500th post with keen advice for young doctors. We did it. We have published a cataract…
Milky fluid leaks out of the intumescent cataract
We have explained over the course of many videos that intumescent white cataracts are challenging. One of the primary considerations…
Quiz: For a pupil like this, what is your approach?
With time, young ophthalmologists develop surgical judgment and they are able to look at a case and decide what approach…
Cataract Surgery using a Scleral Tunnel Incision
Twenty years ago, when I did my residency training at the Jules Stein Eye Institute at the UCLA School of…
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…
Pars Plana Anterior Vitrectomy can be very helpful
When the capsule breaks during cataract surgery and the vitreous prolapses into the anterior segment, it is important to clear…
Review: Be Careful if you see the Hole Punch Sign
In your first 1000 cataract surgeries, the most common cause of a posterior capsule rupture is iatrogenic damage from the…
Alcon PanOptix Trifocal IOL Performance
In the USA, the FDA has recently approved the Alcon PanOptix IOL for use in cataract surgery. This is a…
How to rescue this capsulorhexis before it runs out
Performing the capsulorhexis is one of the most stressful steps for new ophthalmologists who are beginning to learn cataract surgery.…
Quiz: How to fix iris prolapse at the incision
The iris is a kinetic and flowing structure that moves during pupil constriction and dilation. But the iris can also…
Phaco Flip & Chop is great for Beverly Hills Cataracts
Often, the density of the nucleus and the severity of the cataract relates to the patient’s access to healthcare. In…
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…
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…
Top 5 Cataract Surgery Tips for Millennial Surgeons
For the Millennial Eye Live 2019 meeting, I am presenting this talk about my top 5 tips for young surgeons…
Retained Cortex leads to trouble and macular edema
In this anonymously-submitted case, a small amount of lens cortex was left in the capsular bag at the time of…
Checking under the Iris for Hidden Cortex
In cases where the pupil does not dilate fully, it can be difficult to see the entire capsular bag to…
Quiz: What happens with insufficient hydro-dissection?
What happens if the hydro-dissection is insufficient during cataract surgery? The cortex and epi-nuclear shell remain very adherent to the…
Flip up the epi-nucleus for easy aspiration
In some cataract cases it is helpful to perform hydro-delineation to separate the dense endo-nucleus from the softer epi-nucleus. Once…
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…
Needle Puncture for Intumescent White Cataracts
An intumescent white cataract is where the cortex has become opaque and liquified which increases the pressure within the capsular…
Review: if the chop fails, revert to stop and chop
Sometimes we attempt to use phaco chop to divide the cataract nucleus, but we are just not able to achieve…
Cataract Surgery with High Power IOL placement
Cataract surgery can provide an incredible refractive result, particularly for small eyes which are highly hyperopic. We can correct 10…
Should we chop in the bag or above the bag?
Should we chop the nucleus within the capsular bag or should we bring the nucleus partially out of the capsular…
Quiz: A shallowing capsular bag during cortex removal
The irrigation / aspiration probe is placed in the eye and we begin cortex removal. But as we try to…
Tracing a Circle to make the Capsulorhexis
A very simple technique for new surgeons who are struggling with the capsulorhexis is to trace the intended path with…
Overlay the keratome to plan out the incision
In all surgeries, you must make the effort to create a great incision, which I have previously described as part…
What am I thinking while doing cataract surgery?
It’s time for a fun video — what am I thinking while performing cataract surgery? I like the operating room…
Review: Anterior Vitrectomy & Sulcus IOL Placement
With vitreous prolapsed into the anterior chamber, we must perform a vitrectomy before placing the IOL in the eye. In…
Beginner Surgeon attempts a dense white cataract
Dense white cataracts are challenging for multiple reasons: the opaque lens blocks any red reflex, the capsular bag may be…
Calibrating your mental capsulorhexis calipers
Our ideal capsulorhexis will overlap the optic edge for 360 degrees in order to hold the IOL securely in a…
Optimizing the Red Reflex during Surgery
Illumination through the ophthalmic microscope is important for visualization during cataract surgery. We use a combination of both coaxial and…
Two-Step Technique for PSC & NS Cataract
We have shown videos for soft posterior subcapsular cataracts where we prolapse the entire lens out of the capsular bag…
The Chop will not propagate through the cataract
With a dense cataract, a fibrous posterior plate can develop within the lens nucleus. This makes is challenging to split…
Vertical Chop & Horizontal Chop in the same case
Phaco chop is my preferred method of nucleo-fractis for cataract surgery. It is safe, efficient, and minimally invasive, significantly reducing…
Review: Adjusting the phaco tip & I/A tip
For coaxial instruments like the phaco probe and the irrigation/aspiration probe, what is the best position for the silicone sleeve…
Let’s watch a resident perform divide-and-conquer
Many residents choose divide-and-conquer as the first nucleo-fractis technique to learn during residency training. This technique has been featured here…
Tilt and Chop – a SupraCapsular Technique
Supracapsular phaco techniques are in closer proximity to the corneal endothelium, which can be damaged by the ultrasonic energy from…
Quiz: What size is this Capsulorhexis?
We want a capsulorhexis to be just large enough to overlap the optic of the IOL in order to hold…
SupraCapsular Technique for Softer Nuclei
For a relatively soft nucleus, such as in a younger patient with primarily posterior subcapsular cataract changes, the supracapsular technique…
The Viscoelastic Wave for Dispersive Agents
When we inject the dispersive viscoelastic at the beginning of the case, our goal is to protect the corneal endothelium…
Adjust the speculum to make access easier
We often will move the positions of our incisions to provide a better result for the patient or a more…
Review: Making the ideal single plane incision
This is such an important step of cataract surgery that we must review it again as our residents are beginning…
Removing the last nuclear piece
When we break the cataract nucleus into smaller fragments, we can sometimes have one of these small pieces stuck in…
Descemet Membrane Endothelial Keratoplasty
The skills learned from cataract surgery, such as working within the anterior chamber and pivoting within the incisions, can be…
Quiz: Why won’t this nucleus rotate?
This patient has a relatively opaque cataract with a pre-operative vision of only counting fingers. When we go to perform…
Understanding Force Directions in Phaco Chop
Many resident surgeons find it challenging to learn the technique of phaco chop because of the force vectors which are…
Adjust the Phaco Probe Angle during Chop
The phaco probe angle changes during the procedure. When we embed the phaco tip into the nucleus, the probe is…
For wandering eyes, fixate with the chopper
Under topical anesthesia, there are some patients who have a difficult time holding still during critical parts of the surgery…
Review: How to hydrate and seal the phaco incision
A properly constructed phaco incision will allow good access to the anterior chamber for cataract surgery and then will seal…
Cataract surgery & Phakic IOL removal
Posterior chamber phakic lens implants can effectively treat a large degree of myopia while retaining the accommodation of a youthful…
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…
Quiz: What is this large central opacity?
Quiz time: What is this large central opacity seen in the anterior chamber? The patient is scheduled for cataract surgery…