When you encounter a Morgagnian cataract, the cortex has completely liquefied, allowing the dense nucleus to sink to the bottom of the capsular bag. This creates a specific visual cue known as the triangle sign. As you look through the surgical microscope, the superior portion of the capsular bag appears clear (or milky) while the inferior part is occupied by the darkened nucleus. The shape formed by the lens equator and the top of the sunken nucleus creates a distinct triangular appearance. Identifying this early is crucial because the lack of structural support from a solid cortex makes the capsulorhexis more challenging. By recognizing the triangle sign immediately, you can adjust your technique to avoid a runaway tear and ensure a safe start to a complex case. I recommend opening the anterior lens capsule and then filling the inside of the capsular bag with viscoelasatic. Full details in the video.
