Clinical Ophthalmology (Jul 2024)
Automated Capsular Decompression to Avoid Argentinian Flag Sign in Intumescent Cataract
Abstract
Victor Andrighetti Coronado Antunes,1 José de Mello Rosatelli Neto,2,3 Bernardo Kaplan Moscovici,2,4,5 Daniel Filipe Oliveira Rabelo,2 Victor Akio Sano,3 Richard Yudi Hida2,6 1Instituto de Olhos de Assis (IOA), Assis, São Paulo, Brazil; 2Department of Ophthalmology and Visual Sciences, Federal University of São Paulo (UNIFESP), São Paulo, São Paulo, Brazil; 3HOFTALMED – Eye Hospital, São José dos Campos, São Paulo, Brazil; 4Department of Ophthalmology, Hospital Visão Laser, Santos, São Paulo, Brazil; 5Instituto Suel Abujamra, São Paulo, São Paulo, Brazil; 6Department of Ophthalmology, Universidade de São Paulo (USP), São Paulo, São Paulo, BrazilCorrespondence: Bernardo Kaplan Moscovici, Department of Ophthalmology and Visual Sciences, Federal University of São Paulo (UNIFESP), Rua Cayowwa 854, ap 82, São Paulo, São Paulo, 05018-001, Brazil, Tel +55 11996140730, Email [email protected]: We describe an alternative automated technique that consists of simultaneous anterior capsule puncture and decompression of the capsular bag by using an insulin needle attached to the aspiration tubing of the phacoemulsification device to prevent the occurrence of the “Argentinian Flag sign” during capsulorhexis in intumescent cataract.Setting: Instituto de Olhos de Assis and Center of Specialties Hoftalmed, located in the state of São Paulo, Brazil.Design: Prospective interventional study.Methods: Eighty-eight eyes of 88 patients with white or intumescent cataracts were included in this study. Routine clear cornea incision, capsule staining with trypan blue, intracameral anesthesia, and ophthalmic viscoelastic device were used before the procedure. A 26-gauge needle was connected to the phacoemulsification aspiration tubing using a double male Luer connector for irrigation, and aspiration was inserted into the anterior chamber through a new paracentesis incision with the bevel facing down. Immediately after insertion, automated aspiration of the liquefied cortex was performed to remove anterior intralenticular material and achieve capsular decompression. Compression of the nucleus with the needle tip was performed to remove any liquefied material trapped between the posterior surface of the nucleus and the posterior capsule. All surgeries were performed using the same phacoemulsification and parameters. The rate of complete continuous capsulorhexis was observed and noted.Results: No complications were observed in any of the cases. A single-stage, continuous, and well-centered capsulorhexis was achieved in 100% of cases.Conclusion: We conclude that a simultaneous puncture and decompression of the capsular bag using an insulin needle attached to the aspiration tubing of the phacoemulsification machine effectively avoided the “Argentinian Flag sign” in intumescent cataract surgery.Keywords: intumescent cataract, complication, white cataract, capsulorhexis, capsulotomy, cataract surgery, Argentinian flag
