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.…