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Mahmood El-Gasim, Kateki Vinod, Christopher C Teng; Preventing the Argentinian Flag Sign During the Extraction of White Intumescent Cataracts: Phaco Capsulotomy Experience. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):683.
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© ARVO (1962-2015); The Authors (2016-present)
The extraction of white intumescent cataracts is challenging. During the creation of the capsulorhexis, the pressure of the cataract can cause spontaneous tears in the capsule that extend to the periphery (Argentinian flag sign). The aim of this study is to evaluate the effectiveness of phaco capsulotomy in preventing the Argentinean flag sign.
This is a retrospective review of 21 patients with white intumescent cataracts who underwent cataract extraction using phaco capsulotomy. All surgeries were performed by or under the supervision of a single surgeon at the New York Eye and Ear Infirmary between July 2010 and December 2013. Visual acuity (Va), intraocular pressure (IOP), corneal (K) edema, and anterior chamber (AC) inflammation was evaluated pre-operatively and at 1 week, 1 month, and 3 months post-operatively. Intra-operative and post-operative complications were noted.
A continuous curvilinear capsulorhexis was achieved in 20 patients (91%). There was a significant difference between mean pre-operative Va (1.87 ± 0.41 LogMar units) and 3-month Va (0.92 ± 0.87 LogMar units) (p < 0.005). There was no significant difference between pre-operative and 3-month IOP, K edema, and AC inflammation (p > 0.05). Wound burn (WB) was a complication in 5 patients (24%). Three of these patients (60%) developed a postoperative leak and 1 patient required a second surgery to repair the leak. In patients with WB, a 2.2 mm micro-incision phacoemulsification tip (small phaco tip) was used during phaco capsulotomy in 4 patients, and a 2.75 mm standard phacoemulsification tip (large phaco tip) was used in 1 patient. In patients with no WB, a large phaco tip was used in all 16 patients. Using a small phaco tip was significantly associated with WB when compared to using a large phaco tip (p < 0.005). In patients with WB, the mean improvement in Va was 0.57 ± 1.1 LogMar units over 3 months. In patients with no WB, the mean improvement in Va was 1.48 ± 0.3 LogMar units over 3 months. Patients with no WB had a significantly greater improvement in Va over 3 months when compared to patients with WB (p = 0.02).
Phaco capsulotomy is successful in preventing Argentinian flag sign in patients with white intumescent cataracts. A potential complication is wound burn, which can ultimately decrease improvement in visual acuity. A larger phaco tip may prevent wound burn.
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