Sewing Needle Microcapsulotomy - A Novel Innovative Technique To Avert Argentinian Flag Sign

Published 2023 - 41st Congress of the ESCRS

Reference: PO0361 | Type: Free paper | DOI: 10.82333/gmkz-rc94

Authors: Arvind KUMAR Morya* ¹ , Aparajita Sinha ² , RAJENDRA PRASAD ³

¹OPHTHALMOLOGY ,ALL INDIA INSTITUTE OF MEDICAL SCIENCES,HYDERABAD,India, ²OPHTHALMOLOGY ,National Health Services ,WORECESTERSHIRE,United Kingdom, ³OPHTHALMOLOGY ,RP EYE INSTITUTE,NEW DELHI,India

Purpose

We aim to demonstrate our new innovation - Sewing needle microcapsulotome , to avert Argentinean flag sign during capsulorhexis in intumescent cataracts . It is a complication during capsulorhexis in intumescent cataracts , which arises instantly after initial prick by sharp hypodermic needle . It is known that raised intralenticular pressure is responsible for propagation of the initial prick into a radial tear.To counter this several techniques including small needle aspiration technique had been described but the extension of the capsular tear has still seen instantly after pricking the capsule with hypodermic needle.So other factor that is a linear cut configuration with discontinuous open edges with the needle are responsible too.

Setting

So we came up with a hypothesis that if we are able to manually create an opening in the anterior capsule with a round regular configuration like a capsulotomy with round continuous circular edge without any discontinuity that will not tear away with a sudden outburst of the intralenticular fluid. We developed a novel instrument sewing needle microcapsulotome with round pointed tip like a sewing needle system .

Methods

Tip is approximately 0.75mm in length , 0.60mm in diameter and angled at 90 degrees to the distal shaft. On puncturing the capsule it creates a round hole opening with a smooth margins unlike the linear cut .After proper visco in the AC through the main incision , the sewing needle microcapsulotome is inserted . Tip of the needle is placed vertically over the center of capsule , tip is then moved downwards to penetrate through the taut anterior capsule.

Round pointed tip creates a round opening with a smooth margins at the centre of the capsule . Pressurized intralenticular fluid gushes out as a volcanic eruption through the hole which decreases the intralenticular pressure and helps in the decompression of the capsular bag.

Results

Evacuation of the intralenticular fluid including the posterior compartment fluid is achieved by tapping the capsule . An intended 5-5.5mm of capsulorhexis is initiated after tearing the central hole using a rhexis forceps and easily completed without the risk of peripheral extension .

Conclusions

To conclude sewing needle microcapsulotome with circular round hole puncture of the anterior capsule along with pressure decompression is the simplest of technique which enables to prevent Argentinian flag sig. Sewing needle capsulotome is simple and effective tool and is an ideal device to open up tense anterior capsule to adequately decompress the bag prior to the initiation of the capsulorhexis.