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Khiun Tjia MD
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When a hypermature intumescent cataract is punctured without any precaution, it can suddenly “explode” with an instantaneous anterior capsule rupture extending into the zonules. This is known as the “Argentinian Flag” sign due to the juxtaposition of a clear white cataract zone between Vision Blue dyed capsule. Khiun Tjia, MD, shares pearls for approaching suspected swollen hypermature cataracts to avoid the Argentinian Flag sign.
Posted: 6/24/2011
Khiun Tjia MD
When a hypermature intumescent cataract is punctured without any precaution, it can suddenly “explode” with an instantaneous anterior capsule rupture extending into the zonules. This is known as the “Argentinian Flag” sign due to the juxtaposition of a clear white cataract zone between Vision Blue dyed capsule. Khiun Tjia, MD, shares pearls for approaching suspected swollen hypermature cataracts to avoid the Argentinian Flag sign.
Posted: 6/24/2011
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Joke de Boer
7 years ago
This is a very useful video.
mostafa A aziz
13 years ago
nice tips,I agree with Echols point no need to puncture then stain also because time after puncture is important , it should be reduced as we can,the main points in brief small entry (entries) to prevent vsd scape out side ,stain, central puncture, aspirate fluid cortex,,some times with all precautions the rhexis scape through the other side,infact I use bimanual I/A , I prepare my sideports and use it for more aspiration from opposit sites, when I feel no more intralenticular pressure it easy to continue,thanks
J E
14 years ago
Why do you puncture capsule first and then do trypan? You lose all visibility until you flush it out. Why not place trypan into AC under air bubble first? You don't have to "paint" the capsule as much because it disperses among the BSS easier but the endothelium is still protected by the bubble. You haven't punctured the capsule yet so you don't run the risk of accidentally decompressing the eye and having a run-out without your knowledge since you can't see it (I know you aspirated but there's still higher than normal pressure in the periphery and a decompression of the AC can instigate a run-out that may be able to be corrected with more viscoelastic if necessary and if you see it. Finally, you use less viscoelastic because the trypan instilled into an AC with viscoelastic must be flushed out with more viscoelastic.
ari weitzner
14 years ago
but why would a higher pressure in the ac be bad? - as long as there is no iris prolapse, the higher the ac pressure compared to the vitreous pressure, the better.
Thiago Nesi
14 years ago
The most important thing to do is the aspiration of the cortex before the CCC. The overfill of the AC with OVD is dangerous, because the excessive pressure on the capsule can lead to Argentinian Flag sign too, since there is a difference between vitreous pressure and AC pressure.
ari weitzner
14 years ago
disagree with nesi. high pressure in ac means LESS of a differential between ac and vitreous pressure. its that differential which pushes the lens forward and makes a runaway tear more likely. its the same principle we all use when we re-fill the ac when having difficulty with a rhexis.
Girish Jethwa
14 years ago
Dear DR. Khuin, Good clip. I have uploaded "Prevention of Argentanian Flag Sign" to Youtube before about a year. Please visit http://www.youtube.com/watch?v=ZUu6YN83vEA you can send your comment to jethwag@gmail.com
Thiago Nesi
14 years ago
But when you overfill the anterior chamber, making it too high, you are creating a difference of pressures! Re-fill ok, but not OVERfill!
Mario Zambrano
14 years ago
It should be Argentinian flag "sign" not syndrome, a syndrome is the association of several clinically recognizable features, signs (observed by a physician), symptoms (reported by the patient). #Corrections
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