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Extended capsulorhexis gone under iris, deciding through fluttering flap sign whether to continue phaco or convert

Poster Details

First Author: V.Biala INDIA

Co Author(s):    V. Tewari              

Abstract Details


Inspite of all efforts, at times capsulorhexis extends to the periphery and becomes invisible under the iris. We are in a dilemma whether to continue with phaco or convert. By continuing with phaco, chances of nuclear drop are there and by converting to SICS/ECCE disadvantages of larger incision are always there. We want to share with our colleagues, the Fluttering Flap Sign by which we are sure when to continue with phaco and when to convert.


A solo practice centre about 20 kms from New Delhi, the Indian capital. About 60 phaco surgeries are performed every month, each case being video recorded


We have used this method in 18 cases when rhexis had extended under the iris. We were not sure whether the extended margins had reached upto the posterior capsule or not. By following the fluttering flap sign which means, we have to observe the margins carefully whether they are inverted and facing towards the optic disc and the movement of margins is not there or the margins are everted and facing towards the cornea and the margins are freely mobile by a gush of fluid with the syringe. In 2 cases out of 18 in whom the margins of flaps got inverted and were non mobile, conversion was done. In 16 other cases in whom the margins were everted , the phacoemulsification was continued, the bottle height was decreased and the parameters were reduced to have a low flow phaco. In 15 such cases, phaco was completed. In 1 case while performing phaco as soon as the margins got inverted towards the optic nerve, phaco was stopped immediately and conversion was performed. By observing this sign, nucleus did not drop and in 15 cases the phacoemulsification was accomplished. A video showing all aspects of fluttering flap sign will be shown.


In 18 cases of extended rhexis, phacoemulsification was completed successfully in 15 cases and in 3 cases, timely decision was taken to convert and nucleus drop was avoided.


This is a very sure shot sign to decide in cases of extended rhexis, whether to continue phaco or convert without the risk of dropped nucleus and unnecessary conversions in all cases of extended rhexis.

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