In cases of intumescent white cataracts, particularly those with high intra-lenticular pressure, using a Nd:YAG laser to perform an anterior capsular puncture can be a safe and controlled method to decompress the capsular bag prior to coming to the operating room and initiating manual capsulorhexis. This technique involves delivering low-energy laser pulses, typically 1.0 to 2.0 mJ, to create a small central opening in the anterior capsule, allowing liquefied cortex to slowly egress and reducing the risk of the Argentinean flag sign. This preoperative step can improve visualization and reduce the risk of radial capsular extension when performing continuous curvilinear capsulorhexis. What do you think about this technique?
Also this video is from Prof. Dr. Naren Shetty from Narayana Nethralaya in Bangalore, India which is an amazing and truly world-class eye institute which hosts the annual His Master’s Voice cataract and refractive meeting which I have attended the past few years and will attend again in 2026.
