With a white cataract, typically the cortical layers opacify and may partially liquify, and that can make the surgery more challenging. We have previously covered many different topics about white cataracts including dense white cataracts, milky white cataracts, and even ways to differentiate white cataracts. When a patient waits so long that all of the cortex and even epi-nucleus liquifies, we end up with a Morgagnian cataract. This is when the dense cataract endo-nucleus is floating within a capsular bag which is filled with liquified lens proteins. At the slit-lamp microscope we can see the endo-nucleus sink to the bottom of the capsular bag. The photo above is the appearance of the central endo-nucleus after aspiration of the milky lens fluid.
Our guest surgeon today is Larry Patterson MD from Crossville, Tennessee, USA and he uses a sharp, small gauge needle on a syringe to aspirate the fluid from within the capsular bag prior to attempting the capsulorhexis. He also demonstrates how dense and fibrous the nucleus is and how it should be broken apart. Finally, he is using a depot injection of steroids to avoid having to use topical post-op drops. The surgeon for the video is Dr Patterson, however I am giving the commentary.
Click below to learn how to deal with a Morgagnian Cataract: