Morgagnian Small Pupil Hard Nucleus Sponttaneous Rupture Cataract Surgery

We present a case of Morgagnian cataract presenting with exceptional complexity. The patient exhibited a light-perception cataract with a hard nucleus, small pupil, floppy iris, and preoperative spontaneous partial capsular rupture complicated by glaucoma. The surgical difficulty was so high that all other hospitals declined to operate. However, driven by the patient's desire to regain even minimal vision, treatment was undertaken at Fukasaku Eye Institute.

This patient underwent phacoemulsification cataract surgery with vitrectomy performed concurrently to prepare for nuclear dislocation, as capsular rupture was anticipated. The procedure was performed by a highly experienced surgeon with over 200,000 cases of cataract and vitrectomy surgery.

Surgery for Morgagnian cataracts represents the most challenging and complication-prone cataract procedure. Preoperatively, the patient' vision was light perseption, yet with elevated intraocular pressure was 19mmHg and concomitant glaucoma, the nucleus was already dislocated. Left untreated, blindness will be inevitable soon. Consequently, an experienced surgeon proceeded with the operation, anticipating potential complications throughout. Extracting the hard, prolapsed cataract using PFC and fixing the multifocal lens to the sclera proved extremely difficult. Fortunately, vision was restored. Sharing this challenging surgical technique will likely prove valuable to many ophthalmic surgeons. 

This patient's visual acuity improved from light perception to 20/50 without correction and 20/30 with correction, while intraocular pressure decreased from 19 mmHg to 13 mmHg.

Morgagnian cataracts often lead to blindness when treated with conventional cataract surgery, as numerous complications have already developed. However, for the patient's sake, one must not give up. By thoroughly preparing for and performing both cataract and vitreous surgery, postoperative vision can be achieved.