Methods to reduce endothelial trauma, deal with a floppy iris, and determine IOL power in a keratoconic eye with a shallow chamber and floppy iris are presented.

Phacoaspiration is performed in a 40 year-old patient.  Obtaining an intact capsulorhexis was more difficult because of pre-existing subcapsular fibrosis.

Here we depart from our usual presentation of intraocular microsurgical procedures and techniques . A very elderly patient with early phthisis bulbi, and a blind and extremely painful eye receives a retrobulbar alcohol injection to immediately relieve her intractable pain. The appropriate alcohol concentration and anticipated outcome is also discussed.

Two weeks after uneventful cataract – implant surgery, an IOL exchange is performed in a keratoconic eye because of a refractive surprise.

In this case of phacoemulsification and IOL insertion performed on a highly myopic eye, several steps are taken to reduce the possibility of surgical complications in a hypersensitive patient.

In this myopic patient with low ocular rigidity, I demonstrate both my phaco chop technique and simultaneous astigmatic correction using a pair of full thickness i.e. Penetrating, Limbal Relaxing Incisions.

In this case I discuss implantation of a trifocal IOL with astigmatic correction.  Ascertainment of proper alignment of the toric IOL at the desired corneal meridian is also demonstrated.

In this patient with severe claustrophobia and a moderately shallow AC, I discuss several maneuvers/techniques that can reduce patient anxiety and increase the safety of nucleus removal.

A patient with dysphotopsia requiring IOL exchange has had a prior Yag laser posterior capsulotomy.  After performing a pars plana vitrectomy, a secondary capsulorhexis is demonstrated followed by IOL exchange with optic capture.

In this case, I demonstrate how varying the vacuum setting from 400 to 600 mmHg affects the rate of quadrant removal during phacoemulsification.