A multipronged approach to prevent Argentinian flag sign in intumescent cataracts

Abstract

In this communication, we describe a technique for creation of a single stage, adequately sized capsulorrhexis in intumescent cataracts by depressurizing the anterior and posterior intralenticular compartments in a nonleaky anterior chamber (AC) to prevent capsulorrhexis extension and Argentina flag sign. Initially, an incomplete main-port incision is made by the partial entry of a 2.2-mm keratome. A cohesive dispersive ophthalmic viscosurgical device (OVD) is injected into AC. Standard side-port incisions are made, followed by anterior capsular staining. The fluid cortex in anterior intralenticular compartment is aspirated by puncturing anterior capsule in the center using a 30-gauge needle entered through a separate limbal stab incision. The nucleus edge is gently tipped posteriorly with the needle tip to release the fluid from posterior intralenticular compartment also and as much fluid aspirated as possible. OVD is again injected and capsulorrhexis is performed in a single stage using micro-capsulorrhexis forceps.

Modified capsulorhexis for fluid-filled mature cataracts

“…Moreover, when the planned femtosecond laser capsulotomy rapidly decompresses the swollen lens, the high intracapsular pressure can lead to collapse of the anterior lens surface and a consequent movement of the anterior capsule, resulting in failed capsulorhexis [18,21]. Some authors claim high success rates, creating the CCC when the anterior capsule is kept pressurized, aided by water-tight incisions through which the CCC is performed [8,15]. However, this technique may be very dangerous as the ILP is increased because of pressure in the AC.…”

“…Many techniques for performing capsulorhexis in intumescent cataracts have been described, including a sealed anterior chamber (AC) [8,9], phacocapsulotomy [10], decompression of the ILP through simultaneous capsule puncture and aspiration of the liquid cortex [11], and two-stage capsulorhexis [4,[12][13][14][15][16]. The previously described aspiration and decompression of the ILP involve penetrating the center of the anterior capsule with a needle and simultaneously aspirating the liquid material, while maintaining downward pressure on the lens with an ophthalmic viscosurgical device (OVD) [11].…”

Role of Preoperative Nd:YAG Laser Anterior Capsulotomy in Mature Intumescent Cataracts

“…Despite all studies and efforts to minimize intraoperative complications in intumescent cataract, the complication that might take place within seconds of puncturing of the anterior capsule is that the high intralenticular pressure expands the initial capsule incision in an way with the development of the Argentinean flag sign. 1 It is important to understand that all cataracts that are mature or white may not be truly intumescent cataracts. There is no way to know that a particular lens would behave in a way that it would end up into the Argentinean flag sign in a community setup where intraoperative optical coherence tomography to know the lens thickness is usually not available or possible.…”

“…Extension of the capsulorhexis to the periphery and occurrence of the Argentinian flag sign is high due to high intralenticular pressure. 1 The Argentinian flag sign occurs in intumescent cataracts due to the hyperhydration of the lens fibers. These hydrated lens fibers create anterior and posterior pressures within the capsule separated by an equatorial cortex that has yet to be liquified and thus is still in contact with the capsule.…”

“…Surgery in intumescent cataracts poses a challenge in many ways, as the anterior chamber is shallow. Extension of the capsulorhexis to the periphery and occurrence of the Argentinian flag sign is high due to high intralenticular pressure 1 . The Argentinian flag sign occurs in intumescent cataracts due to the hyperhydration of the lens fibers.…”