CASE REPORT
A 64-year-old man experienced a worsening vision for 2 years. His best-corrected visual acuity was worse than 20/30 OU since he was 20 years old, and he has not been permitted to have a driver’s license.
On the initial examination, his best-corrected visual acuity was 20/300 OD and 20/60 OS. Slitlamp biomicroscopy revealed a solid nucleus that descended to the lower equatorial region and a round, isolated posterior capsular opening that was seen through the hydrated cortex in his right eye.
There was no iridodonesis, and the intraocular pressure was normal. His left eye had a cataractous lens with an opacity of the posterior pole.
The slitlamp appearance of the right eye shows a cataract with an isolated posterior capsular opening (arrow). Slitlamp appearance of the left eye shows posterior polar cataract.
Fundus photograph of the right eye showing crystal-like foamy substances on the macular region. The slitlamp appearance of the right eye 1 week after cataract surgery. The intraocular lens was well centered.
The patient was diagnosed as having morgagnian cataract
DISEASE
Morgagnian cataract is a form of hypermature cataract formed by liquefaction of the cortex and sinking of the dense nucleus to the bottom of the capsular bag.
The name “Morgagnian” derives from Giovanni Battista Morgagni, the 18th-century anatomical pathologist.
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From Choroida — the team behind this siteMANAGEMENT
Surgical removal of the cataractous lens followed by intraocular lens implantation is the treatment modality of choice.
Surgery
- Extracapsular Cataract Extraction (ECCE), Small incision cataract surgery (SICS), or phacoemulsification can be performed for the cataract extraction. This is followed by intraocular lens implantation (posterior chamber intraocular lens (PCIOL )/ anterior chamber intraocular lens (ACIOL).
- Intraocular lens scaffold technique has been described to prevent posterior capsule rupture for phacoemulsification of a Morgagnian cataract. This technique uses the IOL as a scaffold to prevent the vulnerable posterior capsule from rupturing during nuclear emulsification in Morgagnian cataract.
The technique prevents rupture of the floppy posterior capsule by providing constant support to it. The scaffold provides stable inflation of the capsular bag and prevents inadvertent emulsification.
Concurrently, it prevents the dehiscence of weak zonular fibers by minimizing the stress on the zonular apparatus.
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From Choroida — the team behind this siteREFERENCES
- Basic Clinical Science Course (BCSC) of the American Academy of Ophthalmology. Section 11. 2014 – 2015.
- Rozenbaum I. The Faces Behind the Eponyms. Arch Ophthalmol. 2008;126(6):846. doi:10.1001/archophthalmol.2007.63
- Bron AJ, Habgood JO. Morgagnian cataract. Trans Ophthalmol Soc U K. 1976 Jul;96(2):265-77.
- Roger F. Steinert. Cataract surgery 3rd edition. Chapter 1, The pathology of cataracts. CA, USA: Elsevier Inc.; 2010
- Deshmukh S, Bhattacharjee H, Gupta K. “Triangle sign”in Morgagnian cataract. Indian J Ophthalmol 2019;67:137.
- KAUFMAN SI. Morgagnian cataracts and their complications: with report of a case of spontaneous rupture of the lens capsule causing secondary glaucoma. Archives of Ophthalmology. 1933 Jan 1;9(1):56-63.
Read more: Rosette-Shaped Cataract, Christmas tree cataract, Choroidal Folds,Cerulean Cataract, Best 5 ways for retinal photography.
Test yourself
A few questions straight from this article.
-
Morgagnian cataract is best described as which type of lens change?
In Morgagnian cataract the cortex liquefies, allowing the dense nucleus to sink to the bottom of the capsular bag. -
From whom does the name Morgagnian cataract derive?
The eponym honours Giovanni Battista Morgagni, the 18th-century anatomical pathologist. -
What did slit lamp examination show in the right eye of the reported case?
The nucleus had descended to the lower equator, and a round isolated posterior capsular opening was visible through the hydrated cortex. -
What lens opacity was present in the fellow left eye of the reported case?
The left eye carried a cataractous lens with an opacity at the posterior pole, described as a posterior polar cataract. -
Which findings argued against lens subluxation in the reported Morgagnian cataract case?
There was no iridodonesis and the intraocular pressure was normal, arguing against zonular loss or lens-induced pressure rise. -
What did the fundus photograph of the right eye show in the reported case?
The fundus photograph of the right eye showed crystal-like foamy substances over the macular region. -
What is the treatment of choice for Morgagnian cataract?
Surgical removal of the cataractous lens followed by intraocular lens implantation is the treatment modality of choice. -
Which extraction techniques are listed as options for Morgagnian cataract?
ECCE, small incision cataract surgery or phacoemulsification may each be used, followed by a posterior or anterior chamber lens implant. -
What is the purpose of the intraocular lens scaffold technique in Morgagnian cataract?
The implanted lens acts as a scaffold, giving constant support to the floppy posterior capsule and keeping the bag stably inflated during nuclear emulsification. -
How else does the intraocular lens scaffold help during Morgagnian cataract surgery?
By minimising stress on the zonular apparatus, the scaffold also helps prevent dehiscence of already weakened zonular fibres.
