For intumescent white cataracts we must take special precautions. The capsular bag is fluid-filled and pressurized and there is the risk of encountering the complication of the Argentinian Flag Sign. To avoid these there are many different techniques which are appropriate.
One very simple and very effective technique is to puncture the anterior lens capsule and then aspirate fluid from the capsular bag to detumesce it. This can be done with a needle and syringe, but an even more effective method is to follow the lead of Ken Downes, MD from Albuquerque, NM, USA.
Using the phaco probe, Dr. Downes buzzes into the central anterior lens capsule and aspirates the liquified cortex from the cataract. This maneuver instantly decompresses the capsular bag and greatly lessens the risk of the Argentinian Flag Sign. At this point, additional viscoelastic is placed in the eye and then the 5 mm capsulorhexis is performed. The rest of the case proceeds smoothly and without issues.
We can also learn from the phaco chop technique that Dr. Downes uses in this video. He is an expert surgeon and you see this in the technique. The eye stays stationary in primary position as the instruments pivot within the incisions. The chopper is used to disassemble the nucleus but also to move cataract pieces and push them toward the phaco probe tip.
click below to learn this technique from expert guest surgeon Dr. Ken Downes: