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…

Capsulorhexis Pivoting

The key to making a great capsulorhexis is understanding the pivoting technique. This allows us to float within the incision…

Pit Technique for Dense Cataracts

With a dense cataract, there can be a fibrous posterior aspect of the lens nucleus which makes chopping more difficult.…

Complete Case: Soft Cortical Cataract

Another addition to our series on Complete Cataract Cases is this technique for soft cortical cataracts. These cataracts are typically…

Capsulorhexis: Good vs Great

In this picture, the capsulorhexis on the left is good because it is centered, continuous, and an appropriate size, but…

Artificial Intelligence in Ophthalmology

The future is here and John Ladas, MD, PhD gives us a brief lecture about the Rules of the Game…

Review: Why is Phaco Chop not working?

This patient certainly needs cataract surgery because the dense nucleus has a large degree of central opacity and that has…

Toric IOL Alignment Dilemma

In this picture, all of these lines are at the 120 degree meridian, so how do you choose where to…

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…

Cataract Quiz: Where should you make the incision?

Our phaco incisions will induce an astigmatic change in the cornea and we can use that to help achieve a…

Complete Case: Cataract in a Small Eye

Looking at this picture, we can see that the corneal diameter is very small compared to the size of the…

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…

How to Rescue this Capsulorhexis

We have previously discussed the Little Maneuver which is a method of saving a run away capsulorhexis. In this case,…

Review: Pseudo-Exfoliation Cataract Surgery

Pseudo-Exfoliation / Small Pupil / Weak Zonules / Shallow AC (watch video below) A sweet 80 year old patient comes…

Danger: Clear Crescent Red Reflex

When you are mobilizing a dense nucleus and you briefly see a bright, clear, crescent-shaped red reflex, you can be…

Manual SICS with nucleus bisection

SICS is small incision cataract surgery, and it refers to a method of manual expression of the nucleus through a…

Cataract Quiz: What happened here?

Look carefully at this picture: what do you see? There is a three-piece IOL in the sulcus and there is…

The Chopper Push Technique

Watch this video carefully and you will see that the chopper instrument is used just once to create a single…

Complete Case: Chop in the Bag

Again we have a complete case, from start to finish, showing a routine cataract surgery with a phaco chop technique.…

You must learn this before finishing residency

The challenge of residency training is that you have just a limited time to learn surgery. You can read books…

Review: Phaco Incision OCT Analysis

The phaco incision is part of your signature which links you to the patient’s eye forever. Your incision will forever be visible…

Mentally Recovering from Complications

There are only two types of ophthalmologists who never, ever get surgical complications: (1) those who don’t operate, and (2)…

Complete Case: Flomax & Toric IOL

Many of our CataractCoach.com readers have been asking for complete cases, shown from start to finish. There is a lot…

Cataract Quiz: What is hidden in this pic?

Look carefully! There is something that needs to be addressed in this picture — it is not easy to see,…

Cataract Surgery with Pterygium Present

For a patient with both a pterygium and a visually significant cataract, the best option is usually to do the…

What are these lines? What is Reflux?

These lines are the posterior capsule which has found its way into the suction port of the I/A probe. We…

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.…

Posterior Polar without delineation

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…

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…

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…

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…

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…

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…

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…

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…