Abstract
Purpose :
While performing capsulotomies on hypermature cataracts, spontaneous peripheral tears can occur yielding the Argentinian Flag sign. We tested the frequency of Argentinian Flag signs in the absence of zonular fibers on human donor Morgagnian cataracts.
Methods :
Fifty donor eyes with Morgagnian donor cataracts and no other ocular diseases or intraocular surgery were obtained. Lenses with capsular lacerations were also excluded. These lenses were placed in a hypotonic solution for 2-3 days, during which the capsule and the contents inside to swell, increasing the pressure within the capsule without jeopardizing the integrity of the capsular membrane. This swelling was observed with optical coherence tomography. Trypan blue was used to enhance visualization, and incisions were made in the center of the capsule followed by more peripherally.
Results :
Out of the 50 lenses tested, zero of the initial incisions extended to the periphery spontaneously. In majority of the lenses, the capsular incision led to a slight depression of the capsule followed by a leaking of the contents. Similarly, the same phenomenon was observed for peripheral incisions, with no incidents of tears running further into the periphery. Without the tension of the zonular fibers, no incision resulted in extension to the periphery.
Conclusions :
Argentinian flag sign was not observed during the capsulotomy in the absence of zonular fibers. These finding suggest that zonular fibers play a vital role in spontaneous Argentinian flag signs. It also gives an alternative surgical method in combating hyper-mature cataracts by focusing on zonular tension rather than using femtosecond lasers pre-operatively. Future research can be conducted to manipulate the ciliary muscles through cholinomimetic agents in preoperative care to relax the zonules and lower the tension on the capsule.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.