Morgagnian Cataracts Conquered With Confidence

Hypermature Morgagnian cataracts pose a challenge to even the most experienced. This is a new TECHNIQUE which shows how to use the designated intraocular lens as a shield for the intact but vulnerable posterior capsule . The thin and flimsy posterior capsule is prevented from coming in contact with the phaco tip. This technique is simple, safe, and reproducible.

The study was undertaken at Disha Eye Hospital during the period  April 2011 to March 2021.Approval was obtained from the institutional ethics committee.All( 257 eyes ) hypermature morgagnian cases during this period was screened and enrolled for the study.

The cases were put up for cataract surgery by phacoemulsification under topical anesthesia .Written consent was taken from each patient after explaining the pros and cons of the procedure in detail.

Anterior capsule is stained by Trypan Blue. Anterior chamber is filled with high molecular weight viscoelastics viz. Viscoat (Alcon) and careful rehxis of diameter 5.5mm is made in  the anterior capsule. The LIQUIFIED CORTEX is drained off.The nucleus  will freewheel at this stage as there is no epinucleus.The unsupported nucleus is pushed and tumbled to a corner in the capsular bag with viscoelastics like Healon GV(J&J).Now the designated foldable intraocular lens is placed below the nucleus in the capsular bag .Now we have a two tier nucleus ; the cataractous crystalline lens on top of the intraocular lens ,all in the bag. Routine Phacoemulsification is executed.All the cases were  followed up postoperatively on days 1,7,30,90.

257 such cases were done during the study period. All went absolutely fine in 252 cases .One which had a very large and grade 6 nucleus with very little liquefied cortex developed a rent .In one case the rehxis was lost and was managed by other means (manual SICS). One case developed about 60˚zonular dialysis which was managed by CTR.In another 2 cases the bag was lost due to 360 degree dialysis of zonules.

The case which we converted to manual SICS is not a complication of the technique per se. So we had 5 cases amongst 257 cases which did not go as contemplated.252 eyes did fine. So this series had excellent results in 98.05 % cases.

This technique of managing HYPERMATURE MORGAGNIAN CATARACTS is very safe and does not require any additional instrumentation or devices. Anyone can make good use of this technique with confidence .Moreover the IOL can be put in at any stage of the surgery if there is no epinucleus viz. after complete or partial chopping. The rest of the surgery becomes a cakewalk .The posterior capsule remains fully guarded .This new technique teaches how to conquer hypermature morgagnian cataracts with full confidence.