Today we are featuring another great case of MSICS, what I refer to as Manual Shelved Incision Cataract Surgery, where a large incision is used to extract the nucleus whole. Our guest surgeon does a great job with this case and it is a reminder to my USA colleagues that we need to also learn this technique. There are cases where you will find that it is very useful, efficient, and safe for tough cataracts. Please do yourself a favor and make sure that you learn to perform MSICS. video link here ..read more

When performing classic phaco chop, we use the vacuum holding power of the phaco probe to fixate the nucleus while the chopper splits it. This works very well for most cataracts where the 400-500 mmHg of vacuum holding power is enough, but when the nucleus is very dense the force of the chopper can break the occlusion at the phaco tip and the purchase on the nucleus is lost. This becomes like trying to cut a piece of meat with just a knife and no fork to stabilize it. Our guest surgeon does technique where a central trench is made in the nucleus, similar to the phaco pit technique, the rotary ..read more

A Morgagnian cataract is where the lens cortex is so liquefied that the remaining cataract endonucleus floats around inside the fluid-filled capsular bag. In this patient, there is also zonulopathy which poses a risk for capsular damage and destabilization. Our guest surgeon does a great job of using the scaffold technique to insert the IOL behind the nucleus and then also implant a capsular tension ring (CTR) to stabilize the capsular bag. Then the nucleus can be removed. While we typically use the IOL scaffold technique to remove nuclear pieces in the presence of a posterior capsule defect ..read more

Combining cataract surgery with glaucoma surgery can be a good fit and we have done that for many decades because cataract surgery alone typically has a pressure-lowering benefit. Many years ago there was a debate about performing phaco with trabeculectomy to determine if two incisions (temporal corneal phaco incision plus superior scleral incision for the trab) were better than one (using a single superior scleral incision for both the phaco and the trab). This surgery, the deep sclerectomy, is thought to have less risk of complications and side effects compared to a trabeculectomy because i ..read more

I have encouraged my fellow USA ophthalmologists to learn how to perform MSICS: manual shelved incision cataract surgery. It is FAR better than performing the old (and outdated) ECCE surgery that I was taught 25+ years ago (by professors who are already deceased or close to it). This technique of MSICS is AMAZING and works very well for certain cases even in our fancy neighborhood of Beverly Hills, California, USA. This allows surgeons to extract the entire nucleus with zero phaco power. And I know that it is challenging to learn, but it is well worth the time investment. This case shows a yo ..read more

We have already covered the topic of the Double Capsulorhexis Technique to prevent the Argentinian Flag Sign in cataract surgery for intumescent white cataracts. This video shows our guest surgeon performing this double rhexis technique for a white cataract in a case of MSICS. Manual Shelved Incision Cataract Surgery. This is a technique that every ocular surgeon should know and here will show you the details to make learning easy! video link here ..read more

This video shows case 500 from a young surgeon who was not given special treatment and who was actually judged on pure merit! If you have already done 500 or 1000 cases, you need to watch this video carefully and ensure that you are delivering the same high level of care. Bravo to this young surgeon who is really delivering excellent surgical results. video link here ..read more

I am ready to break some hearts and be totally honest: you must stop being a snowflake and accept the reality that when you finish your residency/fellowship, you will be in a community where you will attempt to compete with a pro like me. A shark. A killer. A machine who will bring the A+ game. And how are your skills? This video shows what EVERY senior resident surgeon in the USA must be able to achieve to survive in the real world. This video shows about the same level that I could achieve at case 170. Now that I have tens of thousands of cases under my belt, I am bringing an even higher le ..read more

We have a good number of “armchair quaterbacks” here on CataractCoach.com and they sometimes message me to explain what would be a better approach or what was missed in the surgery. Ok champs, show me what you’ve got, lol!!! Look at this pic above (BEFORE watching the video big boss!) and tell me how I know that I am not done yet? This is a totally routine case with a monofocal toric IOL and a goal of plano with the pre-op Rx being +2.50 – 1.00 x 78 and the K values commensurate with that. When I look through the microscope, my view is much better than the 1080p video shown here (1920×1080 pi ..read more

Sometimes with cases of angle closure glaucoma, we need to perform a peripheral iridectomy or peripheral iridotomy. Now all of us eye surgeons would prefer to perform a laser peripheral iridotomy in the clinic instead of bringing the patient to the operating room for a surgical procedure. However, we cannot always be this fortunate and there are times when we need to perform a surgical peripheral iridectomy. You can use micro-scissors or the 23g vitrector to make these peripheral iridectomies (iridotomies) and this video shows how to achieve that. rgical peripheral iridectomy. You can use mic ..read more