Cataract Quiz: Why did the capsule rip?

This resident surgeon recently experienced quite a surprise: when he injected viscoelastic at the beginning of the surgery, the anterior…

Toric IOL for Posterior Polar Cataracts?

We know that with posterior polar cataracts, there is a congenital weakness in the posterior capsule at the site of…

Uveitic Dense White Cataract

This dense white cataract is further complicated by being an a uveitic eye with a fibrotic membrane causing a small…

Cataract Quiz: Why is the cornea cloudy?

This is a routine cataract surgery case. It is very efficient and a minimal amount of ultrasound energy is used…

Complete Case: Pressurized Cataract

This is an interesting case of a young patient, in his mid 40s, who sustained ocular trauma and developed a…

Review: 4 quadrant chop-and-conquer

Many ophthalmologists in training start out by learning the four quadrant divide-and-conquer technique, which has a long history of being a…

Resident Case: improve white cataract chop

In this anonymous video from a resident in Germany, we look to improve the horizontal chop technique in a dense…

Resident Case: improve stop-and-chop

In this anonymous video from a resident in the USA, we look to improve the stop and chop technique. This…

Resident Case: improve tilt and chop

In this anonymous video from a resident in Argentina, we look to improve the tilt and chop technique. This young…

Resident Case: improve vertical chop

In this anonymous video from a resident in India, we look to improve the vertical chop technique. This young surgeon…

Resident Case: improve horizontal chop

In this anonymous video from a registrar (resident) in the UK, we look to improve the horizontal chop technique. This…

Resident Case: improve flip and chop

In this anonymous video from a resident in South Korea, we look to improve the flip & chop technique. This…

Review: Sealing Phaco Incisions

A properly constructed phaco incision will allow good access to the anterior chamber for cataract surgery and then will seal…

climbing up the surgical skill bell curve

Learning surgery, particularly micro-surgery, is very difficult. No one is born knowing how to work within the 0.25 cubic centimeter…

traumatic cataract with bulging capsule

This 23 year old patient was involved in an accident and developed bilateral traumatic cataracts. When we examine the patient…

Critiquing my old cataract surgery video

I was digging through some old computer files and I came across an old video that I made in 2006.…

Resident recovers from capsule break

In the course of learning cataract surgery, resident ophthalmologists will encounter complications such as this posterior capsule rupture. The key…

Expert Surgeon versus The Rock

There is so much to be learned by watching other surgeons operate. Even after so many thousands of cataract surgeries…

Which resident will win this contest?

Residents often prefer to learn divide-and-conquer as the first nucleo-fractis technique for phaco surgery. This requires making a central groove…

Review: Slow Motion Phaco Chop

In the course of giving lectures across the USA and around the world, I meet many experienced ophthalmologists who find…

You must learn to do MSICS

In many countries where dense, brunescent cataracts are common, the SICS (small incision cataract surgery) or MSICS (manual small incision…

Soft cataracts can be quite difficult

Most surgeons associate dense cataracts with increasing difficulty during cataract surgery because they require more ultrasonic energy to break up…

Cataract Quiz: Use the can-opener now?

During capsulorhexis creation, this resident surgeon loses control of the anterior capsule edge and it runs all the way out…

the hemi-nucleus tuck technique

One of the challenges in phaco surgery is that we need to break up the nucleus in order to remove…

Removing OVD from behind the IOL

Surgeons in training often ask, “Do I need to remove the viscoelastic from behind the IOL at the end of…

Draining a choroidal hemorrhage

We recently featured a video of a sudden choroidal hemorrhage which happened during implantation of an IOL. This is a…

Review: Soft-Shell OVD technique

The Soft-Shell Technique for viscoelastic use in cataract surgery was developed by Dr. Steve Arshinoff as a method of getting the best…

Learn as I coach this resident

Many ophthalmologists from around the world have asked if we offer a fellowship, externship, or clinical rotation so that they…

Mastering Divide-and-Conquer

Most young ophthalmologists start learning phacoemulsification cataract surgery with the divide-and-conquer technique. This is an easier technique to learn than…

Pediatric Posterior Capsulorhexis

Our guest surgeon is Ike K. Ahmed MD from the Prism Eye Institute in the greater Toronto area. He is…

Dense Cataract Vertical Chop

For a dense cataract, the vertical chop technique works well because the chop will propagate through the nucleus. We have…

Spiral Capsulorhexis Technique

After needle decompression of the cataract, using a spiral technique for the capsulorhexis has a distinct advantage: if there is…

Review: if the bag shallows during cortex removal

The irrigation / aspiration probe is placed in the eye and we begin cortex removal. But as we try to…

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…

Submarine Chop for dense cataracts

For a dense cataract, performing phaco chop is challenging because the central lens nucleus is so hard that the chop…

White cataract needle decompression

We know that an intumescent white cataract is fluid-filled with liquefied lens cortex. This makes the pressure within the capsular…

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…

Complete Cataract Case: a very special case

This is a complete cataract case, shown from the making of the first incision to the sealing of the incision.…

Ruptured Globe: Key Teaching Points

Every ophthalmologist must know how to manage a ruptured globe. In this case it is a corneal laceration with a…

Review: Surgical Peripheral Iridotomy

here are times when you will need to make a surgical iridotomy either during cataract surgery or as a stand-alone…

Small incision glaucoma surgery

This video is amazing — when I first saw this technique, I was in awe because I learned so much.…

resident divide-and-conquer case 30

An anonymous resident sent in this video of his/her 30th cataract surgery which was done with the divide-and-conquer technique. The…

Cataract Quiz: Argentinian Flag Sign

Cataract Quiz: How can you prevent the dreaded Argentinian flag sign now? White cataracts can pose a challenge when performing…

Simplified pterygium technique

There is so much to learn about truly artistic pterygium surgery that we could likely make a PterygiumCoach.com website and…

Residual posterior polar opacities

We love to show posterior polar cataract videos and we have an entire category for them here on CataractCoach. Using…

Small pupil, PXF, and IFIS

For a beginning surgeon it is helpful to see surgeons performing techniques that are out of your comfort zone. The…

Review: Double Capsulorhexis for White Cataracts

Intumescent white cataracts pose a challenge because the lens cortex has degenerated so much that is has liquefied. This creates…

Pars plana anterior vitrectomy

The only ophthalmologists who have zero surgical complications are those who don’t operate and those who are not fully truthful.…

Expert level dense white cataract surgery

It is a pleasure to watch a true expert perform his craft and this is especially true for cataract surgery,…

Quiz: Why are there two main incisions?

Cataract Quiz: Why are there two phaco incisions in this eye? This is a routine cataract surgery and the case…

Fixing severe capsular phimosis

In a small number of patients, capsular phimosis can happen after cataract surgery. This can lead to severe distortion of…

Tough posterior capsule opacity

When a patient presents with a dense posterior sub-capsular cataract and there is difficulty removing all of the opacity, how…

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,…

Review: fixing beginner mistakes

Learning intra-ocular surgery is not easy and it can take years just to be comfortable with just the basics. Look…

The Subtleties of Cataract Surgery

The difference between good cataract surgery and great cataract surgery comes down to subtleties. There are very slight nuances to…

Bilateral brunescent cataract surgery

This patient has been functionally blind for 10 years and presents to us with bilateral, dense, brunescent cataracts. We must…

Quiz: What is different about this cataract?

Look carefully at the picture above and you will see something that is different about this white cataract. It is…

Resident Cataract Surgery Final Exam

Today is June 30 and that is the final day of residency training in the USA since our academic year…

Analysis of Resident Surgery Steps

This video features side-by-side double camera angles so that we can simultaneously see the microscope view as well as the…

Fluidic Analysis during Phaco Chop

It can be helpful to see the machine fluidic parameters in real-time as the phaco chop procedure is performed. We…

Review: capsule attachments with femto-laser

This young patient (about 40 years old), developed a white cataract which has severely impaired vision in this eye for…

Paired Incisions to fix Astigmatism

This is an easy technique that can be so helpful to all cataract surgeons. By using paired phaco incisions, we…

Pearls for small pupil cataract surgery

There are some great surgical pearls for dealing with small pupils during cataract surgery and this video explains some of…

Cataract Quiz: Why shift the capsulorhexis?

Looking at the picture above it seems like the capsulorhexis has been shifted nasally: it is much closer to the…

Complete Case: Cortical Cataract

With a cortical cataract, patients are very symptomatic, particularly if the cortical opacities are within the visual axis. These tend…

Resident Case Double Camera Angles

For experienced surgeons (which I define as those who have done at least a few thousand cataract surgeries), the microscope…

Complete Case: a very special patient

As a surgeon, it is always an honor when a colleague trusts you to operate on his eyes or on…

Review: Cataract surgery after prior RK

This patient was very myopic and desired surgical correction many years before the advent of the excimer laser. As such,…

Use Trypan Blue dye before OVD

Trypan Blue dye is very useful in cataract surgery because it can stain the anterior lens capsule which improves visualization…

Complete Case: loose zonular support

Another great video in our series of Complete Cataract Cases: a dense cataract in the setting of loose zonular support.…

Anterior Capsule Rips Uncontrollably

Quiz time: What do you do when the anterior capsule rips uncontrollably in a young patient who is scheduled to…

Complete Case: vertical phaco chop

Another complete cataract case, this time showing the vertical chop technique to split the cataract into two halves. This is…

Resident surgeon does case #100

For all of our young surgeons who are learning cataract surgery, this is a great video because it shows you…

resident toric IOL case double camera angles

Using double camera angles can help newer surgeons learn the nuances of surgery. This video shows a resident surgeon who…

Review: Optimizing Cycle Time Efficiency

Establishing a consistent routine in the operating room is the key for both increased efficiency as well as increased safety.…

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…

Complete Case: Efficient Phaco Chop

Another great video in our series of Complete Cataract Cases. You’ll be able to learn from the very first incision…

Quiz: Should I have used a pupil ring?

This is a tough case and the pupil is smaller than I expected. Should I have used a pupil expansion…

2 approaches to Posterior Polar Cataracts

Studies have shown that 1 out of 3 posterior polar cataract surgeries result in a ruptured posterior capsule. Here’s the…

Pre-Chop with just 2 Choppers

Guest surgeon Dr Valentin Apostolov from Amsterdam shows us his technique for splitting a dense nucleus into small fragments before…

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…

Review: The Angle of Approach for Incisions

The angle of approach of the keratome will determine the tunnel length of our phaco incision. If the angle is…

Tough cataract case for a resident

We are thankful for the many video submissions we receive from our readers, particularly from residents or registrars who are…

Enlarge the Capsulorhexis

A small capsulorhexis makes nucleus removal more difficult, especially when we have a dense cataract. When the entire lens hardens…

Complete Case: Floppy Iris & Loose Zonules

There is a benefit to watching a video of a complete cataract case, from start to finish. This is particularly…

Recovering from Argentinian Flag Sign

We have an entire section devoted to achieving success with white cataracts, including intumescent white cataracts. But even in expert…

Cataract Surgery in MegaloCornea

This patient has a huge cornea with a diameter of about 14 mm and an equally large anterior segment including…

Staying calm when you see danger signs

The second that I see this round hole, I know that it is a danger sign. We have previously explained…

Does cataract surgery pose a viral risk?

Our colleagues from the University of Toronto recently did an experiment to determine if cataract surgery poses a risk of…

Cataract Quiz: Which direction for capsulorhexis?

In this Cataract Quiz we have a patient with a white cataract and as we start to tear the capsulorhexis,…

Intra-scleral Gore-Tex IOL fixation

This young patient sustained severe ocular trauma a few years ago and he had a surgical repair done in another…

Descemet Membrane Detachment

When we make a phaco incision that involves the cornea, there is always a risk of having focal detachment of…

Double Hydro-Delination Technique

Hydro-delineation is a useful technique which allows us to separate a central endo-nucleus from an epi-nuclear shell. In this case,…

Lessons from COVID-19

We are now back in our clinics seeing routine patients after almost 2 months of hiatus due to COVID-19. The…

Cataract Quiz: What do you do now?

This is a complication that is sure to happen to every beginning cataract surgeon: a broken posterior capsule as a…

Complete Case: PXF supra-capsular chop

The previous case (reference 611) from yesterday, showed the first eye of this patient where the technique was phaco chop…

Complete Case: PXF chop in the bag

Today (video 611) and tomorrow (video 616) are the two eyes of the same patient who has pseudo-exfoliation syndrome and…

Hydro-delineation makes chopping easier

Performing hydro-delineation helps to separate the denser, central endo-nucleus from the softer epi-nuclear shell. This endo-nucleus is smaller in diameter,…

Review: Chopper protects the capsular bag

We work in a very tiny space of just a fraction of a milliliter: the volume of the anterior chamber…

Toric IOL use in Radial Keratotomy

We have featured many videos of cataract surgery in eyes with prior radial keratotomy. Many of these patients seek out…

Techniques to Open DMEK Grafts

Today was supposed to be the World Cornea Congress in Boston (May 14, 2020) and even though it is cancelled,…

Fixate the eye with your other hand

The problem with using two hands to hold the capsulorhexis forceps is that you lose the ability to have the…

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…

Show me a beautiful cataract surgery

Here on CataractCoach.com we have hundreds of teaching videos, and many of them are of very complex or complicated cases…

Newbie Resident Cataract Surgery

Even experienced surgeons can learn by watching novice surgeons operate. A nickname for a novice is a newbie since the…

Review: Embed the phaco tip without ultrasound

This review is particularly important for ophthalmologists who do cataract surgery for patients with mild to moderate nuclear density. This…

Pre-Chop Variations for Cataract Surgery

In this video, submitted by Dr. Yaun Lin from Casablanca, Morocco, we can learn multiple different variations of Pre-Chop. This…

Expulsive Choroidal Hemorrhage!

This video is a MUST SEE! An expulsive choroidal hemorrhage is a rare complication than any cataract surgeon must be…

Cataract Quiz: Chopper breaks zonules

The resident surgeon has good hands and is talented, but like all new surgeons, he is lacking in experience. The…

Posterior capsule rupture – finish the case

This resident case is a challenge: the posterior capsule is ruptured but there is still cortex to be removed. Can…

Benchmark: Senior Resident Chop

This is a good benchmark for what a senior resident should be able to achieve by the end of residency…

Capsulorhexis forceps with ruler marks

Our guest surgeon is Dr. Ron J. Smith who has been instrumental in teaching cataract surgery at UCLA for the…

Review: IntraCameral Medications

Putting medication directly into the anterior segment of the eye can be very effective. There are many different medications that…

DMEK surgery with pre-loaded graft

We have previously featured Descemet Membrane Endothelial Keratoplasty here on CataractCoach with a video from one of my residents and…

Seems like a good chop but…

Another video for our series of Complete Cataract Cases, we present a surgery of me operating. During this surgery, I…

Cataract Quiz: Rescue this Rhexis!

For this Cataract Quiz we have guest surgeon Dr. Naveen Gopal from Bangalore, India showing us a tough case that…

Congenital Iris Coloboma Repair

We have another video from master surgeon Dr. Valentin I. Apostolov from Amsterdam. In this video he shows us his…

Trabeculotomy & Cataract Surgery

Because cataract surgery alone tends to decrease intra-ocular pressure, there is often a benefit of combining it with glaucoma surgery.…

Resident Surgeon Stop-and-Chop

This is an anonymously submitted video of a resident performing cataract surgery number 60 and the technique is stop-and-chop. This…

Review: Rule of 9s for Sulcus IOL Power

With newly developed methods of IOL power calculation, we are approaching 90% or higher accuracy of achieving +/- 0.5 D of…

Pupillary Cerclage Technique

In cases of chronic traumatic mydriasis, we can use sutures to reconstruct a pupil of a reasonable diameter. We have…

Lens Snare Technique

More than a decade ago in 2009, Dr. Bhattacharya in India described a way of using a lens snare to…

Cataract Quiz: Why did this IOL decenter?

The patient underwent a combined cataract surgery with pars plana vitrectomy. The cataract surgery went well and even today, 1…

Predicting Pseudo-Exfoliation weakeness

We have previously covered the topic of pseudo-exfoliation (PXF) in detail here on CataractCoach. It is an important topic because…

Do not make a baby capsulorhexis

Making small capsulorhexis makes the cataract surgery more difficult because it limits access to the capsular bag and makes it…

Review: Why LRIs should be done at the end

Limbal relaxing incisions (LRIs) are useful for treating mild to moderate degrees of corneal astigmatism at the time of cataract…

Secret to Chopping Dense Cataracts

For the phaco chop technique, the nucleus is held stationary by the vacuum level of the phaco probe. This is…

Cataract Quiz: What’s your next move?

You are performing routine cataract surgery and then you suddenly notice that the posterior capsule is open and a nuclear…

Ensuring accuracy of A-scan ultrasound

Correlate A-scan & biometry measurements to improve accuracy in IOL calculations. This case shows how disparate measurements can lead to…

Toric IOL technique with a small pupil

The toric IOL is a great option to address astigmatism at the time of cataract surgery. For the toric IOL…

How to Enlarge a Small Capsulorhexis

Making a small capsulorhexis can make the cataract surgery more difficult. It becomes challenging to bring nuclear pieces out of…

Review: Differentiating White Cataracts

You’ve seen the notation in the patient chart: “DWC” which stands for Dense White Cataract, but there is actually a spectrum of cataracts…

Step-by-step: Malyugin Pupil Ring

To perform cataract surgery in an eye with a small pupil, it helps to expand the pupil to a more…

How to recover from a capsule rupture

It happens to all surgeons, and it is much more common in beginning surgeons: rupture of the posterior capsule during…

Cataract Quiz: When did the bag break?

In this anonymously submitted resident video, there is a break in the posterior capsule during cataract surgery. With the assistance…

Do not withdraw infusion with a capsule break

If there is a break in the posterior capsule, withdrawing the infusion will allow the anterior chamber pressure go to…

Glaucoma Seton Drainage Surgery

In cases of intractable glaucoma, implanting a seton drainage device can be a very effective therapeutic option. The seton tube…

Review: Dispersive vs. Cohesive Viscoelastics

Viscoelastics, also referred to as OVDs (ophthalmic visco-surgical devices), are viscous substances that allow us to make phaco-emulsification easier and…