Phacoemulsification is the main method for elective cataract surgery; however, in some cases (such as hard cataracts, zonular laxity or loss and inadequate pupil dilatation) it can be challenging to complete the surgery without complication even for the most experienced surgeons. In these cases, preoperative planning and cautious intraoperative management are critical to avoid intraocular injury.
During the aging process, human lens undergoes progressive morphological changes, which lead loss of transparency. A hypermature or morgagnian cataract is a condition characterized by fibrous and calcified anterior lens capsule, liquefied cortex material, brownish rock-hard nucleus and zonular weakness. Therefore, most of the cataract surgeons hesitate to perform phacoemulsification in such cases.
In this case-report, we present management of a patient with morgagnian cataract, rigid anterior capsule and small pupil. Interestingly, none of the local eye surgeons offered cataract surgery to the patient previously.
A 73-year-old man presented with bilateral decreased visual acuity. He had visual acuity of light perception in both eyes for nine years, and local eye surgeons had not recommended cataract extraction to him. The patient underwent detailed ophthalmological examinations included slit-lamp biomicroscopy, intraocular pressure measurement (applanation tonometry), dilated fundus examination (+ 90 D) and B-scan ocular ultrasonography. On initial examination, visual acuity was light perception in both eyes. Slit-lamp biomicroscopy revealed bilateral fibro-calcified anterior lens capsule, brownish nucleus and inadequate pupil dilatation (Figure). Intraocular pressure measurements were normal. Dense cataracts did not allow fundoscopic evaluation in both eyes, whereas B-scan ocular ultrasonography revealed no retinal detachment or intraocular mass.
The left eye of 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 following viscoelastic injection into the anterior chamber. Central part of the anterior lens capsule was very rigid and it was not possible to achieve an initial central...