Prevention of Argentinian flag sign in Intumescent cataract by use of simple safety pin

Abstract

Aim & Objectives: Prevention Argentinian flag sign in patients having Intumescent Cataract by reducing raised intralenticular pressure using simple safety pin to create a nick in the centre for capsulorrhexis. Study: Clinical Study (Case series). Participants: 25. Materials and Methods: For Intumescent cataracts; we used Safety pin (with round tip) to puncture the anterior capsule & create one or multiple punctures with round, smooth configuration, without any discontinuity allowing liquified lens matter to express. There by decompressing the bag without peripheral extension of tear. Round hole is used to create mini-rhexis(3mm) that is then converted to desired size (5.5-6 mm) capsulorhexis. Safety pin tip, with round tip Consequences of radial extension of capsulorhexis include: Vitreous loss Nucleus droop Capsular support loss IOL dislocate/decentred by the initial puncture intra lenticular fluid is expressed out. Round hole provides resistance to the force of sudden outburst of intra lenticular pressure & helps to prevent the splitting of anterior capsule. Once the decompression is completed, anterior chamber is reformed with viscoelastic substance. The central hole created using safety pin was then converted to mini- rhexis(3mm) after which capsulorhexis is completed till desired size rhexis (5.5-6mm) without the risk of peripheral extension. To express intra-lenticular fluid and thereby prevent Argentinian flag sign, • we can use Safety PIN with smooth,  round, pointed tip with 0.6 mm diameter,  either angled at 90 degrees or straight one , used to make Initial puncture in anterior capsule . Safety pin angled at 90 degree. Difference between tip and opening created by safety pin and 26 G needle. This was done with proper autoclave and precautions by an expert surgeon in cataract OT in Ophthalmology-Guru Gobindsinh Government Hospital in Department of M.P. Shah Government Medical College Jamnagar. Results: Out of 25 patients; 23 patients showed decreased intralenticular pressure and Argentinian flag sign was prevented. Conclusion: The technique of using safety pin is simple & effective way to decompress the capsular bag by initial puncture in anterior capsule which is round with regular configuration that provides resistance against the disruptive force triggered by high intra lenticular pressure to prevent Argentinian flag sign. It is simple yet highly effective tool to prevent Argentinian flag sign & its consequences.

Keywords: Argentinian flag, Safety-pin, Intumescent cataract, Intralenticular, Capsulotomy