With a Morgagnian cataract, the entire cortex becomes liquified and then the remaining lens nucleus floats within this fluid. In this case the fluid has resorbed and the lens nucleus has become adherent to the remaining lens capsule. This is certainly a challenging case and it has been submitted by Dr. Luis Escaf from Baranquilla, Colombia.
The first challenge is creating the capsulorhexis which tends not to tear in an entirely predictable manner. The next challenge is the density of the nucleus which can make division diffiulty. Dr. Escaf uses his invention, the ultra-chopper, to bury into the nucleus and easily separate it into four quadrants.
While removing the last nuclear quadrants, a break in the posterior capsule is noted. The decision is made to first place the IOL in the eye in a scaffold technique. This IOL scaffold has most recently been described by Dr. Amar Agarwal and colleagues. A single piece IOL is placed in the capsular bag and rotated so that the haptics are 90 degrees away from the area of capsular violation. Other options would be a sulcus IOL or the optic capture technique.
Also be sure to see our previous guest video of another Morgagnian Cataract here.
Click below to watch how an expert handles this tough case: