Safe phacoemulsification surgery for Morgagnian cataracts: a stratified approach

In hypermature Morgagnian cataracts, the absence of epinuclear and cortical cushioning, along with weak zonular support, increases the risk of posterior capsule rupture and bag dehiscence during high-fluidics hard nucleus phacoemulsification. Various techniques to protect the posterior capsule and bag complex have been described. We describe a technique of stratified nuclear emulsification for Morgagnian cataracts, that entails using the outer softer nucleus as a scaffold to protect the posterior capsule and capsular bag. The nucleus is mechanically split into an inner and outer nucleus by the separational forces applied through a strategically placed chopper and a firmly held nucleus. While emulsifying the inner nucleus, the outer softer nucleus acts as a safety cushion for the posterior capsule, preventing inadvertent posterior capsule rupture and capsular bag dehiscence. Finally, the surgery is safely completed by removing the outer nucleus using lower epinucleus phacoemulsification settings.