Manual Shelved-Incision Cataract Surgery (MSICS) is an excellent technique for managing Morgagnian cataracts due to its ability to handle liquefied cortex and dense, mobile nuclei without phacoemulsification. The larger, often self-sealing, scleral tunnel allows safe delivery of the dense nucleus without placing stress on the compromised capsule or zonules. MSICS minimizes the risk of posterior capsule rupture in these fragile eyes and avoids the energy and fluidics of phaco, which can be hazardous in hypermature lenses. But this case also has a surprise waiting… can you guess what?
