Uday Devgan MD author of CataractCoach.com

Our guest surgeon showcases his stop-and-chop nucleo-fractis in a routine cataract surgery and his technique is excellent. He finished his residency training less than one year ago and has likely done about 500 cataract surgeries at this point. We are showing the video from start to finish, at 2x speed so that we can show the entire case in just about 5 minutes.... https://cataractcoach.com//1029-first-year-in-practice-ca/

If you have performed fewer than 10,000 cataract surgeries, you are still in the part of the learning curve where you are learning to hone your efficiency and maximize the safety for every patient. The goal of surgery is to be minimally invasive and maintain the highest margins of safety. Minimally invasive refers to the small incision size, less ultrasonic energy used to break up the nucleus, less fluid required throughout the case, and making every movement in the eye purposeful.... https://cataractcoach.com//1028-keys-to-cataract-surgery-/

Cataract surgery in the setting of pseudo-exfolation is particularly challenging due to the structural weakness that occurs with this disease process. The pupil dilation becomes poor and the zonular support becomes weak as the pseudo-exfoliative process continues over the years. The incidence of pseudo-exfoliation varies depending on patient population, geography, and age. It tends to be more common in older patients as well as those with Scandinavian ancestry, but it has certainly been found to varying degrees in just about all populations across the globe.... https://cataractcoach.com//1027-playlist-pseudo-exfoliati/

Our guest surgeon shows us his technique for suturing an IOL to the iris in a patient with long-standing peudo-exfoliation and dislocation of a three-piece IOL. We have shown a video highlighting this technique previously and there are some important learning points that we should review. The IOL should be a three-piece design, not a single-piece acrylic IOL, which would cause chaffing to the posterior surface of the iris and result in pigment loss, dispersion, and chronic inflammation.... https://cataractcoach.com//1026-suturing-the-iol-to-the-i/

Our guest surgeon, Dr Val Apostolov from Amsterdam, is a frequent contributor to CataractCoach and today he shows us a case of Soemmering's Ring extraction and then a bonus video segment of how he uses viscoelastic to remove the last bit of stubborn cortex during routine cataract surgery. This is a must-see video for this unusual condition -- one day you will need to know the technique to deal with it! click to learn from this video of Soemmering's Ring extraction and bonus OVD trick: https://cataractcoach.com//1025-soemmerings-ring-extracti/

Cataract surgery in an eye with uveitic glaucoma Stepwise approach to surgical success Cataract surgery in eyes with small pupils is a challenge and having a prior history of uveitis makes it even more so due to the iris synechiae when tend to form. Having a glaucoma seton device in the eye makes it even more difficult since the fluidic balance of phaco surgery is altered due to the additional outflow path (see title photo above). [ 701 more words ] https://cataractcoach.com//review-uveitis-glaucoma-catara/

When teaching our UCLA ophthalmology residents at our large county hospital, Olive View UCLA Medical Center, we encounter many patients with untreated vascular disease which has resulted in severe ocular sequelae. Neo-vascular glaucoma, like the name implies, results from growth of new blood vessels in the anterior segment which can be seen on the iris and also in the angle. These cause outflow blockage and this results in a very high intra-ocular pressure, often 50 to 60 mmHg or even more. [ 458 more words ] https://cataractcoach.com//neo-vascular-glaucoma-ahmed-va/

CataractCoach has advised the beginning surgeons to improve the dexterity of the non-dominant hand and this case is a great example of why you must be able to use both hands well. This video showcases an expert surgeon, Dr Hasan Mohidat from Jordan and his technique of using small gauge (23g or 25g) micro-forceps to create the capsulorhexis using a bimanual technique. Click below to learn this expert technique for intumescent white cataracts: https://cataractcoach.com//expert-white-cataract-capsulor/

For techniques such as stop-and-chop or divide-and-conquer, the phaco probe is used to sculpt a trench or groove in the middle of the nucleus. The instruments are placed in this groove and pushed apart so that the nucleus is cracked and split into smaller fragments. In sculpting the initial groove, we must be careful to avoid going through the nucleus and hitting the posterior capsule like in the prior video shown [ 58 more words ] https://cataractcoach.com//21/a-short-groove-is-sufficient/

While it is fun to watch a video of a cataract surgery that involves complicated maneuvers and difficult challenges, this is not what we usually see in our clinics. More than 90% of our patients are routine cataract surgery and that is a good thing, If I am the patient, I want my surgery to be routine and very much average -- I do not want to be that very unusual case! [ 136 more words ] https://cataractcoach.com//complete-cataract-case-routine/

Even with good dilation, cortex can be hidden at the capsular bag equator. In this case, the dilation is about 7 mm at the beginning of the surgery, but still there is a large piece of lens cortex hidden at the capsular bag equator. If this piece is left inside the eye, then it will swell overnight and become much larger and it will free itself from the capsular bag. [ 121 more words ] https://cataractcoach.com//keep-track-of-cortex-during-su/

Plano is not always the goal It would seem logical that emmetropia is the ideal refractive state of the eye. It puts far away objects in perfect focus. Then the natural accommodation of the eye allows shifting of the focus to near points, thereby giving a full range of sharp vision. As we age presbyopia sets in and our accommodative amplitude declines. [ 968 more words ] https://cataractcoach.com//10/18/choosing-refractive-targ/

The path to learning surgery is a long and challenging one. True success requires years of dedication and the passion to consistently learn from every case and evolve your technique every year. We have previously discussed the learning curve and even given a sample learning grid of cataract surgery steps during residency. In my quest to learn more about cataract surgery every week, I frequently follow the teaching of many international experts. [ 286 more words ] https://cataractcoach.com//review-career-paths-for-surgic/

Our quiz features a video from Gustavo Hüning, MD, MBA from Brazil and it shows an unusual situation that happens during IOL insertion. What is the issue here and what will you do now? Click below to learn: https://cataractcoach.com//cataract-quiz-what-happened-he/

The key to splitting a brunescent cataract is to access the central endo-nucleus. This is the densest part of the cataract and a chop created here can be propagated to allow complete cracking and creation of two hemi-nuclear pieces. This video is from Dr. Cristos Ifantides from Denver, Colorado, USA and he has a method of nucleus division that works well in these dense cataracts. [ 102 more words ] https://cataractcoach.com/2020/10/15/rotary-chop-technique/

When the posterior chamber deepens during cataract surgery, it is usually a sign that the posterior capsule has been ruptured. This allows nuclear pieces to sink back into the anterior vitreous and we notice the extra deep posterior chamber. This is the time to stop (without withdrawing infusion from the eye) and add more viscoelastic via the paracentesis incision. This case ends up with vitreous prolapse into the anterior segment which then needs to be cleaned up. [ 71 more words ] https://cataractcoach.com//posterior-chamber-deepens-with/

It is a pleasure to watch an expert surgeon doing cataract surgery and I really enjoyed learning from Dr. Alex Abdo Martins from Brazil. He shows us that we can chop the cataract without using the vacuum holding power of the phaco probe. He accomplishes this by trapping the nucleus between the phaco tip and the chopper, then mechanical forces can be applied to hold and split the cataract. [ 49 more words ] https://cataractcoach.com//10/13/phaco-chop-without-vacuum/

The most common causes of amblyopia are related to either strabismus or an untreated refractive error, particularly in one eye more than the other. That is the case here where the patient does not have significant strabismus, but does have a life-time history of significant anisometropic amblyopia. This patient has a much higher degree of hyperopia in the right eye and this has been the case for the patient's entire life. [ 210 more words ] https://cataractcoach.com//cataract-surgery-with-prior-am/