When puncturing the anterior capsule (causing a decrease in pressure of the anterior capsular chamber), the remaining posterior pressure causes anterior displacement of the lens and subsequent strain on the anterior capsule, leading to radial extension of the capsular tear. The pathophysiologic mechanism is attributed to a highly pressurized lens system the incompletely liquefied cortex of the crystalline lens remains attached at the equator of the lens forming 2 separate anterior and posterior pressures within the capsule. This sign is observed during cataract surgery after puncture of the anterior lens capsule during initiation of the capsulorrhexis. Radial extension of the capsulorhexis during the initiation of cataract surgery is a rare phenomenon and is more common in cases with intumescent cataracts (pressurized capsular bags). Proper identification of incomplete capsulotomy patterns and radial extensions should be managed with careful manual completion of the capsulotomy. The Argentinian flag sign may occur after femtosecond laser-assisted capsulotomy in cases of intumescent cataracts. Furthermore, trypan blue staining is essential to identify possible incomplete capsulotomy patterns and extensions.

Careful observation during FLACS capsulotomy is advised in cases of intumescent cataracts due to the release of cortex into the anterior chamber which may interfere with the delivery of the laser treatment resulting in incomplete capsulotomy patterns. Management of the extension was achieved by separation of adhesions between the incomplete capsulotomy, along with manual completion at the areas of extensions. Radial extension was observed after injection of trypan blue into the anterior chamber. We describe a case of radial extension and its management during femtosecond laser-assisted cataract surgery (FLACS) in a patient with intumescent cataracts.

Argen flag