In this classic teaching moment, a registrar fails to decompress the capsular bag of an intumescent white cataract. Upon the initial puncture, high intracapsular pressure causes the capsule to split instantaneously to both poles, creating the Argentinian flag sign. While jarring, the case remains salvageable. The priority is immediate stabilization with cohesive viscoelastic to prevent further extension. By removing the liquefied cortex and carefully dividing the nucleus away from the radial tears, the surgeon can still achieve a successful outcome. In this instance, a single-piece IOL can still be placed in the capsular bag. This serves as a vital lesson learned: always needle-aspirate the central cortex to depressurize the bag before attempting the rhexis to avoid this high-pressure complication.
