Yesterday’s outstanding CataractCoach Podcast featured Dr Juan Batlle who explained the Blanco-Puncture technique that he learned from Argentinian surgeon Dr Ariel Blanco. This is a method of decompressing an intumescent white cataract in order to neutralize the pressure gradient and prevent the dreaded Argentinian flag sign complication. This method uses a small gauge needle to decompress the lens capsule BEFORE creating a paracentesis or the main incision. I have not yet tried this technique, but after seeing this video, I am looking forward to seeing if this is the ultimate solution. Have you tried this method before? Please comment below.
I have been using a needle puncture technique in a closed system through a tiny paracentesis for intumescent white cataracts for many years….at least a decade. It is not my own technique as I learned about it from others….perhaps Mike Snyder was the first I’ve seen do this? I can’t recall. I’ve never had an Argentinian flag with a white cataract using this.
Dear Dr. Steven Safran, what we were doing many years ago was precisely, as you say,
perform a paracentesis and puncture the cataract through it, but in this surgical act the exact balance of pressures that exist between the intraocular compartments is lost, even if only minimally. The paradigm change in my technique is to puncture the cornea and cataract BEFORE the paracentesis, without losing that true watertight eye and in that lies the key to success in preventing the sign of the Argentine flag. Best regards, Dr Ariel Blanco.
Always do this.
Thanks Drs Devgan and Battle for showing the technique I described and published (https://www.elsevier.es/es-revista-archivos-sociedad-espanola-oftalmologia-296-articulo-blancopuncion-una-tecnica-simple-prevenir-S036566912030321X?referer=buscador). The paradigm shift lies in performing the cataract puncture as the first surgical step, without paracentesis, with the eye sealed.
brilliant, my friend! thank you for this great contribution!