We have extensively covered the topic of white cataracts here on CataractCoach and we have an entire subcategory devoted to it. For an intumescent white cataract, there is a significant amount of liquefied lens cortex which pressurizes the capsular bag and increases the risk of capsular rip. This is often referred to as the Argentinian Flag Sign because the blue-white-blue appearance resembles that country’s flag. This cataract is different because the entire mass of lens proteins has swollen and there is no separate layer of liquefied lens cortex. This makes the technique of needle decompression less likely to work. Other techniques such as the double rhexis or spiral rhexis are also not likely to work well in this case. We can try auto phaco needle aspiration or even a femtosecond laser, but again there is no guarantee that it will work in this case. Perhaps the best technique would be using the phaco probe to create a capsular hole while using high vacuum — we will try this on the patient’s other eye cataract surgery which is scheduled soon.
There are many great pearls in this video and at the end, the result is excellent with a securely placed IOL in the capsular bag. We also include slow motion video so that you can see just how quickly the capsule ruptures.
Click to learn from this amazing video:
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