June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
The Mechanistic Role of Zonular Tension in Argentinian Flag Sign
Author Affiliations & Notes
  • Trishan Patel
    Arkansas College of Osteopathic Medicine, Fort Smith, Arkansas, United States
    Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
  • Philip Dockery
    Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
  • Alireza Ghaffarieh
    Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
  • Footnotes
    Commercial Relationships   Trishan Patel None; Philip Dockery UAMS Jones Eye Institute, Code E (Employment); Alireza Ghaffarieh UAMS Jones Eye Institute, Code E (Employment)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 3312. doi:
  • Views
  • Share
  • Tools
    • Alerts
      ×
      This feature is available to authenticated users only.
      Sign In or Create an Account ×
    • Get Citation

      Trishan Patel, Philip Dockery, Alireza Ghaffarieh; The Mechanistic Role of Zonular Tension in Argentinian Flag Sign. Invest. Ophthalmol. Vis. Sci. 2023;64(8):3312.

      Download citation file:


      © ARVO (1962-2015); The Authors (2016-present)

      ×
  • Supplements
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.

 

The OCT of the anterior portion of the capsule showing the swelling and intact integrity of the capsule.

The OCT of the anterior portion of the capsule showing the swelling and intact integrity of the capsule.

 

Performing the incision on the stained lens and the result of no peripheral extension.

Performing the incision on the stained lens and the result of no peripheral extension.

×
×

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.

×