27/01/2023
What is a morganian cataract? How to detect it? Which surgery to treat it? What equipment should be used? Discover our file.
Morganian cataract is the most advanced stage of cataract. Surgery is the only way to treat it as no medication can cure it.
Moria, a leading manufacturing company in ophthalmic tools, unveils morganian cataract surgery techniques and instruments to use during the intervention.
Morganian cataract is an eye disease that was first discovered by Giovani Battista Morgagni in the 18th century. The name of this type of cataract derives from Dr. Morgagni’s name. It is a type of hypermature cataract caused by the cortex’s liquefaction and the falling of the dense nucleus into the bottom part of the capsular bag.
This form of cataract usually happens when cataract remains untreated. It happens mostly in developing countries with poor ophthalmic treatments[1].
Age as a risk factor of morganian cataract
Cataracts usually appear in the elderly. Morganian cataract is also linked to age, but diabetes and regular exposure to sunlight are also risk factors. If untreated, it can lead to glaucoma and, in more serious cases, to vision loss.
Morganian cataract symptoms
The two main symptoms of morganian cataract are :
Clinical signs of morganian cataract
The following signs can help ophthalmologists diagnose morganian cataract:
[1] J. Brzezinska ⁎, P. Lewandowski, R. Philips - 331 Chirurgie de cataracte de Morgagni par phacoémulsification : à propos de deux cas - EM Consulte (En ligne) - https://www.em-consulte.com/article/213361/331-chirurgie-de-cataracte-de-morgagni-par-phacoem#:~:text=Introduction,%C2%AB%20fluido%2Ddura%20%C2%BB).
[2] Sabin Sahu, MS - Morganian Cataract - American Academy of Ophthalmology (En ligne) - https://eyewiki.aao.org/Morganian_Cataract#:~:text=Morganian%20cataract%20is%20a%20form,the%2018th%20century%20anatomical%20pathologist.
Morganian cataract is characterized by a speed fiber dissolution. Eosinophilic fluid accumulates between lens cells which leads to displacement and degeneration of the surrounding cells. Morganian globules (globules resulting from the cortical cell walls’ breakdown) accumulate and replace the whole cortex, which leads to morganian cataract.
When such stage is reached, the central dense nucleus starts depending on gravity which results in its deplacement to the lower region of the capsular bag lens[1].
[1] Sabin Sahu, MS - Morganian Cataract - American Academy of Ophthalmology (En ligne) - https://eyewiki.aao.org/Morganian_Cataract#:~:text=Morganian%20cataract%20is%20a%20form,the%2018th%20century%20anatomical%20pathologist.
Yes, morganian cataract can be surgically removed by 2 techniques: phaco-emulsification & extra-capsular extraction, although this type of surgery can be slightly more challenging than the one performed to remove cataract at an early stage. The experience of the surgeon and the ophthalmic tools used during this intervention are two key elements that ensure a successful intervention.
Several surgical techniques can be used to make visualization easier during hypermature cataract surgery and to control the creation of a capsulorhexis. These two elements ensure a successful surgical morganian cataract treatment[4].
The creation of continuous curvilinear capsulorhexis
Continuous curvilinear capsulorhexis might be more difficult to perform in morganian cataract. This is mainly due to the high intralenticular pressure that can result in the lens capsule tearing. On the other hand, the surgical challenge of this technique to treat morganian cataract lies on the lack of red reflex and the displacement of liquefied cortical material within the anterior chamber following the capsule opening.
To perform morganian cataract surgery using curvilinear capsulorhexis forceps, surgeons are advised to darken the operating room while increasing microscope magnification as well as coaxial lights.
Improving visualization during hypermature cataract surgery
To stain the anterior lens capsule during morganian cataract surgery and to highlight contrast between the underlying lens and the anterior capsule, trypan blue can be used. The anterior part of the capsulorhexis can thus be seen with more precision. Some ophthalmic surgeons also use side illumination using an endoilluminator in order to get a better visualization of the capsular tear.
Limiting the risk of uncontrolled capsular tear during morganian cataract surgery
When performing morganian cataract surgery, there is a high risk of uncontrolled capsular tear. To avoid this, capsulorhexis can be performed in two stages. The surgeon starts by making a small continuous curvilinear capsulorhexis. The content of the liquefied lens is then aspirated.
The advantage of this two-stage technique is that there are less unexpected radial tears.
IOL implantation
The last stage of hypermature cataract surgery is the implantation of an intraocular lens (IOL) through small incisions. The IOL is an artificial lens that replaces the original natural one during cataract surgery. IOLs come in various types and allow the patient to get their eye vision back right after the morganian cataract surgery[5].
[4] Amanda C. Maltry, MD; Anna S. Kitzmann, MD - Morganian Cataract - The University of Iowa (En ligne) - http://webeye.ophth.uiowa.edu/eyeforum/cases/146-morganian-cataract.htm
[5] Yoshihiro Takamura, MD, PhD; Namiki Oishi, MD; Eri Kubo, MD, PhD; et al - Morganian Cataract With an Isolated Posterior Capsular Opening - Jama Network (En ligne) - https://jamanetwork.com/journals/jamaophthalmology/fullarticle/415723
To ensure success of morganian cataract surgery, the following instruments by Moria can be used during each stage of the intervention:
Recovery time
Patients can see a few hours after the morganian cataract surgery, although vision might remain blurry for a few days. To avoid infections, ophthalmic surgeons usually prescribe antibiotics in the shape of eye drops.
During the first week that follows the intervention, make-up must be avoided and when showering, patients have to make sure no water enters the eyes. Eye pressure must be kept low. That is to say: no heavy physical activity.
Any abnormal pain following the intervention must be reported to the surgeon as quickly as possible[6].
Results to expect after morganian cataract surgery
Morganian cataract surgery usually provides really good results as long as it is performed by a good surgeon using the right ophthalmic instruments such as ophthalmic tools by Moria.
Patients can see again right after the intervention. The result continues to develop overtime as patients follow the postoperative advice given by their surgeon[7].
Possible complications following hypermature cataract surgery
The following complications can occur after a morganian cataract surgery:
[1] Allen Omid Eghrari, M.D., M.P.H. - Cataract Surgery Recovery: 5 Tips From an Expert - Johns Hopkins Medicine (En ligne) - https://www.hopkinsmedicine.org/health/wellness-and-prevention/cataract-surgery-recovery-5-tips-from-an-expert
[2] Alsubari Alwan1,& et Riani Mohammed1- Cataracte morganienne - National Library of Medicine (En ligne) - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5837139/
[3] Sabin Sahu, MS - Morganian Cataract - American Academy of Ophthalmology (En ligne) - https://eyewiki.aao.org/Morganian_Cataract#:~:text=Morganian%20cataract%20is%20a%20form,the%2018th%20century%20anatomical%20pathologist.
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Last update: 22/04/2024
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