Peripheral iridotomy to prevent Argentinian flag sign during capsulorhexis in the white cataract

摘要

The Argenentian flag sign is a serious complication of cataract surgery for intumescent lenses. We believe that a major cause is the rapid pressure efflux from the posterior to anterior chambers when they are united during capsulorhexis, creating rapid pressure equilibration and an anterior capsule tear. This pressure gradient is largely determined by in-tralenticular forces from a hydrated cataract within the bag, but it is accentuated by extracapsular forces originating posteriorly or equatorially that squeeze more cortex through any anterior capsule opening in an uncontrolled fashion (Figure 1). Furthermore, extracapsular equatorial forces accentuate the partition formed intralenticularly by the nucleus between the anterior and posterior pressurized compartments of the cortex, as described by Figueredo et al. as another etiology of the flag sign.