Argentinean
flag sign is most common complication for intumescent
cataracts
OCULAR SURGERY NEWS
12/15/2000
To prevent this complication, choose the
right viscoelastic and avoid tension on the lens.
Daniel Mario Perrone, MD
Argentinean flag sign is the name I have chosen
to describe the most common complication when
performing capsulorrhexis in intumescent cataracts
stained with trypan blue.
When a spontaneous tear in the capsule extends
into the periphery, the appearance of the stained
capsule beside the white cataract mimics the blue-white-blue
arrangement of the Argentinian flag. This complication
inspired me to create a video, which received
awards at the 2000 American Society of Cataract
and Refractive Surgery and the European Society
of Cataract and Refractive Surgeons video competitions.
As I say in the video, “It is not the case
I dislike my flag, but I’d rather not remember
it in that way.” Therefore, it is important
to avoid this complication.
Steps to avoid it
To avoid this complication, first of all, choose
the correct viscoelastic agent. Sometimes we use
hydroxymethylcellulose in routine cases, but with
white cataracts we should maintain a deep anterior
chamber during the capsulorrhexis process, because
anterior displacement of the irido-lens diaphragm
produces centrifugal forces that lead the tear
toward the periphery.
Thus it is mandatory to use highly cohesive viscoelastic
agents.
A second issue is to avoid creating outer and
inner tension on the lens. External tension can
be caused by the speculum, especially in narrow
orbits. Another cause may be excess in parabulbar
anesthesia. In such cases, the main reason is
the high tension on the lens capsule due to hyperhydration
of lens fibers. Sometimes I prefer to decompress
the lens with a small puncture, allowing the milky
liquid to escape from the lens.
Despite being aware of all these issues, sometimes
the Argentinean flag sign may be raised.
Management
Whenever the tear leads toward the periphery,
we should begin a new tear to correct it. But
in this case, we have two tears — one anterior
to the other. Therefore, we will have to finish
the rhexis in a can-opener style or re-grasp the
tear after creating a new one. This can be done
with a bent needle, forceps or micro-scissors.
The next step is nucleus management. It is a must
to avoid perpendicular forces against the capsular
tear because of the high risk of extending the
tear toward the posterior capsule. The nucleus
can be cracked or divided into two heminuclei
with a soft vertical chop or with a sculpting
technique. Phacoemulsification should be done
in the iris plane. Fortunately, these cataracts
are not too hard.
IOL implantation may be done in the bag, taking
care not to enlarge the existing tear and placing
the haptics perpendicular to it.
Remember, if you are an Argentine surgeon and
the Argentinean sign comes up, try to suppress
your patriotic feelings and quickly solve this
complication.
 |
 |
| With hydroxymethylcellulose
viscoelastic, anterior displacement
of the iris-lens diaphragm produces centrifugal
forces that lead the tear toward the periphery
(top). In cases of white cataract, the anterior
chamber must be supported by highly cohesive
viscoelastic agents (bottom). |
 |
 |
| During the execution of the rhexis,
a tear into the periphery is noted. |
Capsulorrhexis is begun on
a white stained with trypan blue for visibility. |
 |
 |
| The Argentinian flag. |
When the tear extends in both directions,
its appearance mimics the Argentinian
flag. |
 |
 |
| Nucleus management is a
must to avoid perpendicular forces against
the capsular tear. |
IOL implantation may be
done in the bag. |
|
Una cirugía que devuelve la visión
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del 2003
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una lente multifocal.
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2005
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Provincia de Córdoba.
FECHA: 21 de Octubre
del 2003
Argentinean flag sign is most common complication
for intumescent cataracts
MEDIO: OCULAR SURGERY
NEWS
FECHA: 12/15/2000
|
