Topic > Cataract surgery: Phacoemulsification - 672

Introduction Phacoemulsification is the main method for elective cataract surgery; however, in some cases (such as hard cataracts, zonular laxity or loss, and inadequate pupil dilation) it may be difficult to complete the surgery without complications even for the most experienced surgeons. In these cases, preoperative planning and careful intraoperative management are critical to avoid intraocular injury. During the aging process, the human lens undergoes progressive morphological changes, which lead to a loss of transparency. A hypermature or Morgangnian cataract is a condition characterized by a fibrous, calcified anterior capsule, liquefied cortical material, a rock-hard brownish nucleus, and zonular weakness. Therefore, most cataract surgeons hesitate to perform phacoemulsification in these cases. In this clinical case, we present the management of a patient with Morganian cataract, rigid anterior capsule and small pupil. Interestingly, none of the local eye surgeons have previously offered cataract surgery to the patient. Case Report A 73-year-old man presented with bilateral decreases in visual acuity. He had visual acuity of light perception in both eyes for nine years, and local eye surgeons had not recommended cataract extraction. The patient underwent detailed ophthalmologic examinations that included slit-lamp biomicroscopy, intraocular pressure measurement (applanation tonometry), dilated fundus examination (+90 D), and B-scan ocular ultrasound. On initial examination, visual acuity was light perception in both eyes. Slit-lamp biomicroscopy revealed a bilateral fibrocalcified anterior capsule, a brownish nucleus, and inadequate pupil dilation (Figure). Intraocular pressure measurements were normal. Dense cataract… middle of the paper… nian cataract could pose a challenge to any surgeon. Lenticular morphological changes could influence the surgeon at any stage of phaco surgery. However, preoperative measures against potential risks can facilitate the performance of successful phaco surgery in cases of Morganian cataract. What was known: Numerous nuclear fracture techniques were developed to make phaco surgery more efficient and safe, while most of these techniques focused on first crack nuclear fracture surgery. What this article adds: In phaco surgery, Removal of the first lens piece is critical and provides more endocapsular space, so subsequent manipulations become easier. Our technique allows the surgeon to cut the first nuclear piece easily and safely under direct visualization of the lens periphery, a difference from the classic "stop and cut" technique. References Figure legends