CHALLANGES AND SURPRISES IN SURGERY OF MORGAGNIAN CATARACT

The evolution of a cataracted lens can sometimes lead to the liquefaction of the cortex and sinking of the nucleus in the capsular bag.  The main challanges in operating a Morgagnian cataract refer to the control of the rhexis, due to the high intracapsular pressure and the phacoemulsificaton of the restant nucleus, usually a very hard one.

Faculty of Medicine, University “Lucian Blaga” din Sibiu, Romania

ARCADA Clinic Sibiu

We present a case of a bilateral Morgagnian cataract managed through irrigation-aspiration.

The ophthalmological exam revealed: RE BCVA – light perception (l.p.), LE BCVA – light perception (l.p), with an intraocular pressure (IOP) of 18 mmHg in the right eye (RE) and 20 mmHg in the left eye (LE). Central corneal thickness (CCT)  was RE 545µm, LE-535µm.

The anterior segment exam was typical for a hypermature cataract OU. There was no view of the posterior segment. The B-scan did not reveal any abnormalities of the fundus.

 During surgery, the anterior capsule was stained with trypan blue dye, and a 5-mm capsulorrhexis was attempted. Difficulties were encountered from the beginning. After puncturing of the anterior capsule, visualization immediately decreased as the liquefied cortex leaked into the anterior chamber. Under careful maneuvres, using OVD, capsulorrhexis was successfully performed. Subsequently, all the crystalline material was removed through irrigation-aspiration.

The patient’s visual recovery was excellent, with a clear cornea and 20/25 visual acuity on postoperative day 1. The patient was prescribed a regimen of postoperative topical anti-inflammatory and antibiotic eye drops with follow-up recommended for 1 week.  He had her second eye cataract surgery 2 weeks later with similar results.

Morgagnian cataract is a type of hyper-mature corticonuclear cataract. Cataract surgery in this cases is challenging. Various complications may occur during and after surgery. The cortex in this type of cataract undergoes liquefaction, resulting in the sinking of the dense nucleus in the capsular bag. In addition, the unique challenge with a Morgagnian cataract is the escape of liquefied cortical material that blurs the vision during the creation of the capsulorrhexis.