This is a routine case during which I discuss anticipation and prevention of problems caused by patient coughing, infusion misdirection syndrome, and finally the intracameral antibiotic controversy.

In this case I demonstrate techniques used to remove a dense nucleus in an eye with pseudoexfoliation. Signs of Infusion Misdirection Syndrome and methods to protect the posterior capsule when this problem exists are also presented.

After first removing the anterior subcapsular cataract in a highly myopic patient, I then demonstrate the use of intraoperative aberrometry to confirm the toric IOL power calculation. Discussions include how to best manage a significantly deep chamber and how to correct the rare occurrence of a toric IOL that rotates postoperatively.

In order to perform cataract surgery upon this non-English speaking patient, I first have to remove an iris-fixated anterior chamber lens implanted 11 years previous. This case highlights removal of the phakic IOL, the value of a translator during surgery and the use of intraoperative aberrometry to determine the correct IOL power.

This case demonstrates the use of intraoperative aberrometry plus the Aphakic Refraction Technique to best determine the final IOL power in a keratoconic eye. Tips for visualization, a comparison of phaco chop and divide and conquer and the advantages of a high IOP setting round out this very educational case.

Patience is a critically important trait for all surgeons to develop and maintain. In this patient, Dr Mackool demonstrates its value during removal of a red/brunescent cataract in a one-eyed patient.

In response to viewer requests, this video demonstrates the Divide and Conquer procedure using a curved ultrasonic needle (Balanced Tip). A useful method of eyelash isolation is also shown.

An eye with a shallow anterior chamber is at increased risk for endothelial cell loss during phacoemulsification. A convex anterior capsule increases the risk of anterior capsulotomy “runout”.

In this case I discuss and demonstrate techniques that protect the endothelium and prevent capsulorhexis problems in these eyes.

Determination of the correct IOL power for a highly myopic eye with posterior staphyloma is fraught with difficulty. Here I employ two methods that can permit measurement of both the spherical and astigmatic power of the desired IOL, including the degree of “retinal astigmatism” caused by the staphyloma. I demonstrate the use of both wavefront technology and the Aphakic Refraction Technique (manifest refraction) to calculate the power of the IOL that is then inserted on the day following
cataract removal.

This patient has persistent negative dysphotopsia after cataract-implant surgery performed 18 months ago. A combination of techniques is used to achieve the desired reposition of the IOL optic (reverse optic capture).

Treatment of one diopter of astigmatism is also demonstrated by the placement of 2 penetrating limbal relaxing incisions (PLRIs) at the steep corneal meridian.