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Antunes VAC, Rosatelli Neto JDM, Moscovici BK, Rabelo DFO, Sano VA, Hida RY. Automated Capsular Decompression to Avoid Argentinian Flag Sign in Intumescent Cataract. Clin Ophthalmol 2024; 18:1915-1920. [PMID: 38974664 PMCID: PMC11226184 DOI: 10.2147/opth.s465837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/19/2024] [Indexed: 07/09/2024] Open
Abstract
Purpose 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.
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Affiliation(s)
| | - José de Mello Rosatelli Neto
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
- HOFTALMED – Eye Hospital, São José dos Campos, São Paulo, Brazil
| | - Bernardo Kaplan Moscovici
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
- Department of Ophthalmology, Hospital Visão Laser, Santos, São Paulo, Brazil
- Instituto Suel Abujamra, São Paulo, São Paulo, Brazil
| | - Daniel Filipe Oliveira Rabelo
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
| | - Victor Akio Sano
- HOFTALMED – Eye Hospital, São José dos Campos, São Paulo, Brazil
| | - Richard Yudi Hida
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
- Department of Ophthalmology, Universidade de São Paulo (USP), São Paulo, São Paulo, Brazil
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Nayak B, Lalitha CS, Moharana B, Panda BB. Double peak sign on ultrasonography: A new prognostic marker before surgery for white cataract. Indian J Ophthalmol 2024; 72:S712-S714. [PMID: 38324632 PMCID: PMC11338405 DOI: 10.4103/ijo.ijo_2418_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 11/03/2023] [Accepted: 12/01/2023] [Indexed: 02/09/2024] Open
Abstract
A mature, hypermature, or white cataract needs posterior segment evaluation before surgery for prognostification. Ultrasonography is the preferred method for this. White cataract or intumescent cataract risks intraoperative capsulorhexis running out leading to devastating complications due to high intralenticular pressure. Altghough sligh-lamp examination before surgery can gives clue regarding fluid pockets under anterior capsule in these types of cataract, fluid in posterior compartment of lens can be detected by ultrasonography. The author here described a new sign, the double peak sign which can predict the high intra-lenticular pressure especially in posterior compartment of the lens. So if it detected before surgery, all precautions can be taken during surgery to prevent complications. The A-scan overlay on the B-scan in ultrasonography can detect the hypoechoic area corresponding to the lequified cortex in between solid lens nucleus and posterior capsule, so giving rise to the double peak sign which is described here as an innovation.
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Affiliation(s)
- Bhagabat Nayak
- Department of Ophthalmology, AIIMS, Bhubaneswar, Odisha, India
| | - C S Lalitha
- Department of Ophthalmology, AIIMS, Bhubaneswar, Odisha, India
| | | | - Bijnya B Panda
- Department of Ophthalmology, AIIMS, Bhubaneswar, Odisha, India
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LoBue SA, Rizzuti AE, Martin CR, Albear SA, Gill ES, Shelby CL, Coleman WT, Smith EF. Preventing the Argentinian flag sign and managing anterior capsular tears: A review. Indian J Ophthalmol 2024; 72:162-173. [PMID: 38273682 PMCID: PMC10941923 DOI: 10.4103/ijo.ijo_1418_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/09/2023] [Accepted: 10/25/2023] [Indexed: 01/27/2024] Open
Abstract
The Argentinian flag sign (AFS) is a feared complication during cataract extraction. Intralenticular pressures, especially excessive posterior pressure, have been identified as potential mechanisms for capsular stress and tearing associated with AFS. Capsular tension is created by positive intralenticular pressures, which cause the irido-lens diaphragm to move anteriorly once the manual capsulorhexis has been initiated. This tension can cause inadvertent tears that self-propagate to the lens equator, causing an AFS, among other intraoperative complications. Thus, this review highlights the importance of identifying intumescent cataracts as well as a combination of techniques to relieve intracapsular pressures needed to prevent AFS. However, some instances of anterior capsular tears are unavoidable. Therefore, focus will also be placed on techniques during cataract extraction used to manage anterior capsular tears, mitigating extension to the posterior capsule.
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Affiliation(s)
- Stephen A LoBue
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, USA
- Department of Ophthalmology, Willis-Knighton Medical Center, Shreveport, LA, USA
| | - Allison E Rizzuti
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Curtis R Martin
- Department of Ophthalmology, Willis-Knighton Medical Center, Shreveport, LA, USA
| | - Sinan A Albear
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Ekjyot S Gill
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, USA
- Department of Ophthalmology, UCLA Stein Eye Institute, Los Angeles, CA, USA
| | - Christopher L Shelby
- Department of Ophthalmology, Willis-Knighton Medical Center, Shreveport, LA, USA
| | - Wyche T Coleman
- Department of Ophthalmology, Willis-Knighton Medical Center, Shreveport, LA, USA
| | - Edward F Smith
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, USA
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Ifantides C, Sretavan D. Automated precision pulse capsulotomy vs manual capsulorhexis in white cataracts: reduction in procedural time and resource utilization. J Cataract Refract Surg 2023; 49:392-399. [PMID: 36729849 DOI: 10.1097/j.jcrs.0000000000001109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/21/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE To compare the utility of precision pulse capsulotomy (PPC) with manual capsulorhexis for capsulotomy in white cataracts. SETTING Hospital-based academic practice. DESIGN Retrospective analysis of surgical case records and surgical videos from a single surgeon. METHODS Cases involving intumescent and nonintumescent white cataracts were identified. Capsulotomy outcomes, surgical outcomes, procedural time, and resource utilization, as well as patient demographic and health data, were analyzed and subjected to statistical testing. RESULTS 15 cases of white cataract (10 intumescent and 5 nonintumescent) performed using continuous curvilinear capsulorhexis (CCC) were compared with 20 cases (9 intumescent and 11 nonintumescent) performed using PPC. The cases covered a period of 14 months before and 30 months after surgeon adoption of PPC. There were no significant differences between the 2 groups in patient age, sex, ethnicity, ocular history, medical history, and medications. PPC resulted in complete capsulotomies without tags or tears and intracapsular intraocular lens implantation with 360-degree capsular overlap in all 20 cases. There was 1 CCC case resulting in the Argentinian flag sign. Compared with CCC, PPC white cataract cases also demonstrated significant advantages in capsulotomy time, reduced use of trypan blue and ophthalmic viscosurgical device, and less overall procedural time. CONCLUSIONS PPC is a safe and highly effective method to create consistent capsulotomies in both intumescent and nonintumescent white cataracts. The use of PPC provides benefits of significant reductions in capsulotomy time, overall procedural time, and resource utilization, resulting in a streamlined treatment of these complex cataract surgery cases.
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Affiliation(s)
- Cristos Ifantides
- From the Tyson Eye, Cape Coral, Florida (Ifantides); Department of Ophthalmology, University of Colorado, Aurora, Colorado (Ifantides); Centricity Vision, Inc., Carlsbad, California (Sretavan)
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Mahajan S, Sood G, Garg R. Vacuum rhexis - A novel capsulorhexis technique for white cataracts. Indian J Ophthalmol 2022; 70:4043-4046. [PMID: 36308154 PMCID: PMC9907310 DOI: 10.4103/ijo.ijo_1631_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Capsulorhexis in white intumescent cataract is often associated with extension leading to radial tears or biradial extension "Argentinian flag sign" and associated complications. We describe a novel technique of managing this situation. Vacuum rhexis is performed with a 24 G bent cannula attached to a 10-ml syringe. The flap is lifted and then caught using 24 G cannula. The suction is manually controlled by the surgeon, and the rhexis is completed using circumferential movement. The chamber stability is well maintained as there is no leakage, and the bent tip gives excellent fulcrum for movement. The advantage of this technique is that a single port is used for maintaining the chamber stability and it needs no special surgical instruments. Vacuum rhexis is a novel surgical technique used for performing successful continuous curvilinear capsulorhexis (CCC) of adequate size in white and intumescent cataracts, with a consistent and predictable outcome.
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Affiliation(s)
- Sandeep Mahajan
- Department of Cataract and Refractive Services, SM Eye Hospital, Kangra, Himachal Pradesh, India
| | - Gitanjli Sood
- Department of Cataract and Refractive Services, SM Eye Hospital, Kangra, Himachal Pradesh, India,Correspondence to: Dr. Gitanjli Sood, S M Eye Hospital, Zamanabad Road, Kangra, Himachal Pradesh - 176 001, India. E-mail:
| | - Ravi Garg
- Department of Cataract and Refractive Services, SM Eye Hospital, Kangra, Himachal Pradesh, India
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Abbas AA, Bu JJ, Chung J, Afshari NA. Recent developments in anterior capsulotomy for cataract surgery. Curr Opin Ophthalmol 2022; 33:47-52. [PMID: 34854828 DOI: 10.1097/icu.0000000000000820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW Successful anterior capsulotomy is an important step in cataract surgery. This article reviews the various anterior capsulotomy techniques available to surgeons to optimize the step, including those that have become available since the introduction of femtosecond-laser-assisted cataract surgery (FLACS). Studies comparing the relative advantages of each technique will be emphasized. RECENT FINDINGS Manual continuous curvilinear capsulorhexis (CCC) and FLACS remain the two most widely studied techniques for achieving anterior capsulotomy. Each technique has been shown to be effective for a wide range of patients and cataract surgery complications. Meta-analyses have shown that FLACS provides similar results to manual CCC for long-term cataract surgery outcomes. Several alternative methods for anterior capsulotomy have been described, which aim to provide some of the advantages of laser capsulotomy at a lower cost; among these, precision pulse capsulotomy (PPC) and selective laser capsulotomy (SLC) have been investigated the most in the literature so far. SUMMARY Cataract surgeons have an increasing number of techniques for anterior capsulotomy available. Manual CCC and FLACS remain the most widely used, and most well studied. The latest techniques, PPC and SLC, have shown promise in the few studies performed since they were introduced.
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Affiliation(s)
- Anser A Abbas
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Jennifer J Bu
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Jinkwon Chung
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
- Department of Ophthalmology, Soonchunhyang University College of Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Natalie A Afshari
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
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