In the management of an intumescent white cataract, some surgeons like to use the femtosecond laser to create a the capsulotomy thinking that it may mitigate the risk of a spontaneous Argentinian Flag sign. However, this technology is not magic and it is not perfect or infallible. As the laser begins the circular treatment, the high intracapsular pressure can cause an immediate egress of liquefied cortical milk through the initial laser treatment. This opaque, leaking cortex scatters and blocks the subsequent laser pulses, leading to an incomplete capsulotomy. This is why the use of Trypan Blue dye remains mandatory, even in laser-assisted cases. Without staining the capsule, the surgeon cannot visually confirm if the laser achieved a full 360 degree cut. If you do not, like the surgeon in our video, then there can be capsular complications such as this radialization that extends to the posterior capsule.. This mechanical stress caused a radial tear that quickly extended toward the equator and around to the posterior capsule. To avoid such complications, always stain with dye to verify the capsulotomy integrity before any intraocular manipulation.
