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10 - 14 Sept. 2016, Bella Center, Copenhagen, Denmark

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Phacoemulsification in a case with morgagnian cataract, extremely fibro-calcified anterior capsule and small pupil

Poster Details

First Author: I. Toprak TURKEY

Co Author(s):    V. Yaylali                    

Abstract Details


Phacoemulsification of a morgagnian cataract carries high risk of surgical complication; hence, most of the surgeons hesitate to perform phaco surgery in such cases. Typical morphological characteristics of morgagnian cataract comprise brownish dense nucleus, fibrous anterior capsule, liquefied cortex and zonular weakness. In this report, we present peroperative challenges in a case with morgagnian cataract, very rigid anterior capsule and small pupil.


Private Eye Hospital


A 73-year-old man presented with bilateral blindnes for nine years. The patient underwent detailed ophthalmological examinations including slit-lamp biomicroscopy, intraocular pressure measurement (applanation tonometry), dilated fundus examination (+90D) and B-scan ocular ultrasonography. Visual acuity was light perception in both eyes. Biomicroscopy revealed bilateral fibro-calcified anterior lens capsule, brownish nucleus and inadequate pupil dilatation. B-scan ocular ultrasonography revealed no retinal detachment or intraocular mass.


The patient underwent phaco surgery under retrobulbar anesthesia (VY). After 2.75 mm main clear corneal incision, anterior lens capsule was stained with trypan blue dye. Two corneal side port incisions (20 gauges) and mechanical pupil dilatation were performed. Central part of the anterior lens capsule was very rigid and it was not possible to achieve an initial central capsulotomy with cystotome. Therefore, relatively peripheral capsular flab was created and capsulorhexis was completed with the assistance of Vannas scissors. After nucleus removal, cortex material was aspirated with bimanual irrigation/aspiration. Foldable intraocular lens (IOL) was implanted into the capsular bag.


In conclusion, phacoemulsification of morgagnian cataract might be challenging even for the most experienced surgeons. Morphological lenticular changes might enforce the surgeon in any step of the phaco surgery. However, preoperative measures against potential risks can ease to perform a successful phaco surgery in cases with morgagnian cataract.

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