In our many videos about white cataracts (full series can be found here), we know that one of the biggest risks is the dreaded Argentinian Flag Sign. This occurs primarily in intumescent white cataracts and it gets its name from the appearance of the anterior capsule that is split wide open. The two halves of the capsule, which were stained with Trypan blue dye, are separated by a band of white representing the exposed cataract.
This is a treacherous situation because this split can move all the way back to the posterior capsule as well, resulting in a dropped lens nucleus and further complications which can be sight threatening. How can we recover from this complex situation?
Gary Wörtz MD is a trusted colleague and talented surgeon from Lexington, Kentucky, USA. He presents his technique of recovering from this complication. The technique is excellent because he is able to remove the lens nucleus completely without placing any stress on the capsular bag. His solution is a good one: it is to create a can-opener anterior capsulotomy which means that many small areas of run-out are created to help distribute any capsular forces. Remember that prior to the advent of the continuous curvilinear capsulorhexis (ccc), a can-opener style anterior capsulotomy was the normal for routine phaco cases.
Click below to learn from this excellent rescue by Dr Wörtz: