We have seen the videos before where the Argentinian Flag sign develops instantly as the anterior lens capsule splits uncontrollably. Just watching a video of this makes me uncomfortable and when it happens during surgery, it is even worse.
This happens because unlike most routine cataracts, the white intumescent cataract is fluid filled and has an increased intra-lenticular pressure. When the capsular bag is punctured to start the capsulorhexis, posterior pressure is exerted on anterior lens capsule and that causes it to tear uncontrollably. This fluid is from liquefaction of the lens cortex so remember that it exists both behind and in front of the cataract endo-nucleus. One way to prevent this is to keep the pressure in the anterior chamber higher than the intra-lenticular pressure. This is accomplished by having only small paracentesis-type incisions and highly inflating the anterior chamber with viscoelastic. We can then work through this small paracentesis using a cystotome/bent-needle or specialized micro-forceps. We can also try to perform needle aspiration of the liquefied cortex, but again, it is not always successful.
But this doesn’t always work. In some patients, particularly the young patients who develop a white cataract quickly over the course of a month or two from trauma, recent onset of diabetes, or idiopathic reasons. In these patients the pressure in the capsule is so high, that as soon as the first opening is made in the anterior lens capsule, despite having a high anterior chamber pressure, milky fluid will egress and the capsule will run out. We have shown previous videos of using a femtosecond laser to try to solve this conundrum, but again it can leave capsular adhesions and tags since the laser is relatively slow. Even phaco puncture has been tried. But what is the gold standard?
After using the Zepto device extensively, it is the ideal device for intumescent cataracts. The Zepto device makes a 5.2 mm opening in the anterior lens capsule in just 4 milliseconds using a very brief burst of energy. This creates a centered, strong, and reliable capsulotomy and prevents the Argentinian Flag sign from ever occurring. This video shows my pearls for success and why it is the gold standard for intumescent white cataracts.
Promoted video. Dr Devgan is a paid consultant to Centricity Vision.