This young patient (about 40 years old), developed a white cataract which has severely impaired vision in this eye for the past two years. We suspected that this white cataract would be intumescent and that there would be a higher risk for the dreaded Argentinian Flag Sign with a manual capsulorhexis. Therefore we elected to use a femtosecond laser to create the capsulotomy in a matter of a couple of seconds prior to making any incisions.
The laser performed well and the capsulotomy was completed without complications. In the operating room, Trypan blue dye was instilled to stain the capsule and then forceps were used to grasp the cut capsule which was not free-floating. The white cataract had focal areas of intensely opaque lens material in close proximity to the anterior lens capsule. At these areas, the capsule was still adherent as there were tags still connecting the cut capsule to the anterior capsular rim.
The key here is to pull the center of the cut capsule up, towards the apex of the cornea to fully separate these persistent attachments.
click below to see the edited video of this technique: