Posterior polar cataracts are unusual, but certainly every ophthalmologist will see these patients in their own clinics. While most surgeons…
Posterior Capsule Rupture! Now what?
In this anonymously submitted case from a resident surgeon in training, there are many great lessons to be learned. We…
Cataract Quiz: Optic-Iris Capture
Happy New Year! It’s Quiz Time: how do you approach this case with optic-iris capture and a dense fibrotic membrane?…
How much force for hydro-dissection?
When we perform hydro-dissection, how much force is needed? What volume of balanced salt solution is required? What are the…
Refining your Surgical Signature
It is so important for surgeons to take pride in their work. You must do a great job, or don’t…
Setting Up for Cataract Surgery
Cataract surgery is team work and the surgeon is just one member of the team. We need a great team…
Review: Posterior Capsulorhexis Technique
If there is a central posterior capsule plaque that cannot be removed with the suction from the irrigation/aspiration probe, we…
Epi-Nucleus Flip Technique
With a thick epi-nuclear shell, it is easier to remove it with the phaco probe as compared to the I/A…
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,…
Cataract Quiz: The chop failed. Now what?
Even for expert cataract surgeons, sometimes the attempt at phaco chop fails. This can be due to many reasons and…
Resident Cataract Case #165 Evaluation
This video is submitted anonymously by a resident ophthalmologist who has completed 164 cataract surgeries so far. This case, his…
Trap a dense nucleus in order to chop it
With a very dense and fibrous cataract, using just the vacuum from the phaco tip to hold the nucleus is…
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…
Review: External View of Cataract Surgery Steps
Two of the most critical steps in cataract surgery are the main phaco incision and the capsulorhexis. Properly completing these…
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…
Toric IOL planning in a small eye (+29.5 D)
Our main phaco incision will induce astigmatism and multiple variables affect the degree of this change. Larger incisions have more…
Cataract Quiz: What is the problem here?
Time for another Cataract Quiz. Look carefully at the photo — the IOL has just been implanted and now it…
Complete Case: Brunescent & White Cataract
This patient truly needs our help. She developed a cataract in the right eye a few years ago and was…
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…
The Smallest Permissible Capsulorhexis
From watching our videos, you know that for most cases, I find that a 5 mm capsulorhexis is ideal. This…
Review: Side View of Hand Position
While we do hold the phaco probe with a pencil grip, we do not use the same angle as writing with…
Trouble learning phaco chop? Try this first
One of the main reasons why phaco chop is more difficult to learn than divide-and-conquer is that there is a…
The patient has a surprise for you…
You have scheduled a patient for cataract surgery and the case seems relatively routine. The biometry was good and the…
Cataract Quiz: Why is there a capsular wrinkle?
This surgery seemed quite routine. A nice capsulorhexis, easy nucleus removal, and complete cortex clean-up. The three-piece IOL was placed…
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…
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…
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…
Review: IOL calcs in high hyperopia
Here is your challenge. You’re operating on a patient who is highly hyperopic (wearing +6.50 OD and +7.00 OS for…
Three-piece IOL: B versus C cartridge
There are two options for injecting an Alcon three-piece IOL using the Monarch injector: the B cartridge is bigger and…
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…
Cataract Quiz: Why is this cortex so adherent?
This seemed like a completely normal case… until it came time for removal of the last bit of cortex, which…
Two-Handed Capsulorhexis Technique
Our guest surgeon is Ravi Goel MD from New Jersey, USA who is also the author of the ProtectingSight.com blog.…
Struggling with Phaco Chop? Let me help you
I will be the first to tell you that mastering phaco chop is not easy, but it is certainly worth…
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…
Review: Cataract Surgery in Pseudo-Exfoliation
We often encounter patients with Pseudo-Exfoliation Syndrome, often abbreviated as PXF, which makes cataract surgery significantly more challenging. The PXF…
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.…
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…
Cataract Quiz: Why did we get bleeding here?
In this resident case, the IOL is in the capsular bag, the capsulorhexis is intact, the viscoelastic has been removed…
Phaco Incision Do-Over
In this case, the resident begins by making a phaco incision that is not good. The roof is too thin…
Recovering from a radialized capsulorhexis
Learning to perform a consistent capsulorhexis is one of the toughest steps of cataract surgery. The anterior capsule is only…
Simplified Technique for LRIs
Limbal relaxing incisions (LRIs) are a great option to treat pre-existing corneal astigmatism at the time of cataract surgery. They…
List of Key Videos for Residents
A young doctor in training asked me to put together a list of key videos prior to her first day…
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…
How far do you insert the Chopper for Phaco Chop?
A young surgeon who is new to phaco chop asked me how deep to insert the chopper tip into the…
Cataract Quiz: What complication will happen next?
Cataract Quiz: look carefully at the IOL in the injector cartridge. Now it’s time to implant the IOL into the…
Resident Surgeon Learning to do Phaco Chop
In your quest to learn phaco chop, it is helpful to watch other beginning surgeons perform the same technique. In…
Can we use a Toric IOL in Keratoconus?
Toric IOLs have the ability to neutralize corneal astigmatism at the time of cataract surgery to improve vision for our…
Spiral Out Capsulorhexis for Intumescent Cataracts
Some white cataracts are intumescent which means that the capsular bag is filled with liquefied lens cortex. This fluid increases…
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…
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.…
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.…
Cataract Quiz: What is this white plume?
The phaco probe is placed in the eye at the beginning of the cataract surgery and when ultrasonic energy was…
Severe Capsular Phimosis
Capsular phimosis occurs when there is severe contraction of the anterior capsular tissue which results in a shrinking of the…
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…
Choosing Toric IOL Steps
For toric IOLs, we need to select the best spherical power as well as the ideal toric step. What is…
Review: 12 Consecutive Capsulorhexes
Seeing the same step of surgery performed over and over again can help beginning surgeons learn the subtleties of the…
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…
Highly Efficient Stop-and-Chop
From watching videos here on CataractCoach.com, you’re aware that my favorite method of nucleus division is phaco chop. Any form…
Quiz: What will happen next? Look carefully
This picture tells me that there is going to be an issue during this case. As soon as the incision…
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…
Tear Out of the Anterior Capsule
In this video, which was anonymously submitted, an experienced surgeon encounters a routine cataract case where the anterior capsule is…
White Cataract with Fibrotic Lens Capsule
This video was submitted by an anonymous surgeon who is attempting this case early in the course of surgical training.…
Review: YAG laser capsulotomy techniques
Posterior capsule opacification (PCO) is common after cataract surgery. Even a perfect surgery by a master surgeon still leads to…
Guest Surgeon PanOptix Tips & Tricks
In the USA, we often get access to new technologies later than other countries due to the hurdles required to…
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…
Cataract Surgery Lessons from Kyoto
I recently went to Kyoto, Japan for ophthalmology business development projects and I also had a chance to visit a…
Clear Optic versus Yellow-Tinted
There has been much debate about the light transmission properties of various IOL optic designs. While most IOLs have a…
Flip and Chop in post-PPV eyes
With a prior pars plana vitrectomy, the anterior hyaloid face is gone and therefore there is less support for the…
Post-LASIK IOL Power Estimation
In eyes with prior LASIK, many different methods of IOL power estimation have been described to get more accurate results…
Review: External View of Phaco Chop
Most of the videos on this site are taken through the operating microscope. This gives the view of exactly what…
Do not vacuum near the corneal endothelium
During cataract surgery, you notice a small lens fragment or an air bubble float up to the corneal endothelium, where…
The chop failed, so I reverted back to this…
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…