Milky fluid leaks out of the intumescent cataract

We have explained over the course of many videos that intumescent white cataracts are challenging. One of the primary considerations is the intra-lenticular pressure created by the liquefied lens cortex. This can result in the dreaded Argentinian Flag Sign complication if it is not properly managed.

This video shows an external view, from outside the surgical microscope, of capsulorhexis creation in a patient with an intumescent white cataract. The main phaco incision has already been made and the anterior lens capsule has been incised with a bent-needle cystotome. The danger in this situation is that the pressure in the anterior chamber is lower than the intra-lenticular pressure and because the relatively large main incision has already been made, it is not easy to increase the AC pressure.

This is the situation where the Argentinian Flag Sign is most likely to happen, as the milky cortex fluid leaks from the capsular bag, it can also allow the nucleus to float up and push against the back surface of the anterior capsule. This force then causes the capsulorhexis to rapidly radialize out to the zonular attachment and often to the posterior capsule.

What are the options for addressing this situation now? We can gently depress the center of the lens nucleus via the anterior capsular opening, with the goal of depressurizing the capsular bag and keeping the nucleus more posterior within the bag. The other option is to just try your luck and complete the capsulorhexis, hoping for the best. In our video, this was the choice of our resident surgeon.

Click below to learn from this case and see if the resident surgeon got lucky:

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