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.

Cataract-implant surgery was performed in a very highly myopic young woman with several disabilities, retinopathy of prematurity and an extremely dense cataract with an appearance that resembles spherophakia.  Phacoemulsification, insertion of capsule retractors, a capsular tension ring and a 40 diopter IOL were done in a necessarily deliberate manner.  General anesthesia was avoided by the reassuring support of the patient's mother who accompanied the patient into the operating room and maintained constant contact with her throughout the operation. Both the appearance of the cataract and logistics of the procedure are rare.

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.