Argentinean Flag Sign
The Argentinian Flag Sign, a term coined by Dr. Daniel Mario Perrone, is a dreaded complication which can occur during capsulorhexis construction on a white intumescent lens. In this video, the complication occurs in a monocular (NLP in his other eye from RD) and deaf patient. Preoperatively, there was no way to communicate with the patient who prior to cataract development had relied on lip reading. Dr. Tal Raviv presents his approach in handling this complication.
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Comments (10)
Thank you for presenting this case. You can decompress even hard lenses with a central puncture using a 27-gauge needle and aspiration, after first using healon-5 to push the lens back and vision blue staining. You must put the 27-gauge needle on at least a 3-ml syringe to gain enough advantage. The lens does not have to contain milky material for this technique to work. You can then complete a continuous rhexis using a flap from the puncture site.
congratulations and thanks for this nice presintation,once it happen creating edges with scissors and enlarging rhexis as much and completephaco in AC as you did is the best choice BUT antecipatig high intralenticular Pr.and avoidance is far better,when expected I used to make narrow AC entry,pressurize the AC better with dispersive viscoelastic,small central capsule puncture, aspirate fluid cortex asmuch26 g canula,by that time capsule will show excavation ,make your keratome incision and complete rhexis,thank you
Thanks for all the insightful comments.
Thank you Dr Tal Raviv for this nice video. I usually achieve decompression by first puncturing the capsule with a round needle and letting the milky cortex escape out slowly.Your decision not to convert at that stage was likely based on your knowledge about the low density of the cataract. Well done.
I would not have thought twice about switching to extracapsular surgery the minute I saw the flag sign!! you have one brave heart sir :)
what you can do in cases where u expect this dont attempt rhexis go directly in phaco mode and open the capsule with phaco this immediately decreases intralenticular prssure and if possible convert to rhexis
ever try pushing down on the lens with 2nd instrument during the rhexis, to reduce the tension? i saw that done in other video.
I should congragulate you for this case. I would prefer to use more dispersive visco elastic like healon 5 or %3 na-hyaluronate. plus vitreus aspiration from 3.5 mm to dcrease the tension on anterior capsule.
excelent movements and very simple tecnic to resolve the faco, but i agree to ranchump, if the nucleus mas much dense i would made the extracapsular sugery.
i agree with your moves here. but if nucleus very dense, i would abandon phaco and open wound and express nucleus.