Morgagnian Cataract With an Isolated Posterior Capsular Opening

A morgagnian cataract is a hypermature cataract in which the total liquefaction of the cortex has allowed the nucleus to sink inferiorly.¹ Herein, we report a rare case of morgagnian cataract with an isolated posterior opening with no history of trauma and its successful management. To our knowledge, this is the first documented case in Japan.

A 64-year-old man experienced 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 (Figure 1A). There was no iridodonesis, and the intraocular pressure was normal. His left eye had a cataractous lens with opacity of the posterior pole (Figure 1B).

The patient was diagnosed as having morgagnian cataract, and he underwent cataract surgery by phacoemulsification and foldable intraocular lens implantation through the small incisions. Limited anterior vitrectomy was performed to manage vitreous loss through the posterior capsular opening. The intraocular lens was implanted safely into the capsular bag without marked enlargement of the posterior capsular rupture (Figure 1C). His corrected visual acuity after surgery improved to 20/30 OD. In the right ocular fundus, crystallike foamy substances were observed on the surface of the macular region (Figure 1D).

The patient's father (Figure 2, I-2) and eldest daughter (Figure 2, III-2) underwent cataract surgery when they were 20 and 30 years old, respectively. In one of the patient's grandchildren (Figure 2, IV-2), posterior polar cataracts were observed in both eyes when the child was 8 years old.

The causes of the rupture of lens capsule were classified by Duke-Elder² as due to blunt or penetrating trauma, suppurative inflammation, intraocular neoplasms, or spontaneous occurrence in hypermature cataracts and lenticonus. Among these causes, several cases of a hole in the posterior capsule caused by blunt trauma have been reported.³ In our case, there was no history of blunt trauma preceding the decrease in vision. We consider that severe clouding was previously present in the posterior pole region in the right eye as it was in the left eye, and fragility of this region may have led to the posterior capsular opening. Actually, there are reports of intraoperative posterior capsular rupture with posterior polar cataract.⁴ However, it is unknown if a hole was made and then progressed to morgagnian cataract, or if a hypermature cataract aggravated and then ruptured the posterior capsule.

In our current case, the onset of cataract occurred at a young age in each generation, which is a feature of autosomal dominant inheritance. Several forms of autosomal dominant congenital cataracts are associated with the genetic heterogeneity. Ionides et al⁵ demonstrated that autosomal dominant posterior polar cataract is associated with the distal short arm of chromosome 1. Such gene mutation may have been present in this our case, but it was not confirmed.

The authors have no relevant financial interest in this article.

Corresponding author and reprints: Yoshio Akagi, MD, PhD, Department of Ophthalmology, Fukui Medical University, Matsuoka-machi, Yoshida-gun, Fukui-ken 910-1193, Japan (e-mail: akagiy@fmsrsa.fukui-med.ac.jp).