Surgical Techniques For The Management Of Intumescent Cataract And Prevention Of The Argentinian-Flag Sign. A Systematic Review.

The purpose of this systematic literature review is to present the surgical techniques and prophylactic measures that can be applied in order to prevent the manifestation of the Argentinean flag sign during cataract surgery.

Argentinean flag sign is a complication that may happen in the stage of capsulorhexis during intumescent cataract surgery. The reason of this complication is the high intralenticular pressure which is the result of the swelling of the lens cortex. Preoperative and intraoperative measures that can be followed to reduce the risk of Argentinean flag sign during intumescent cataract surgery are analyzed thoroughly.

Prospective clinical studies, prospective case series, literature reviews, and surgical techniques related to the surgical management of age-related intumescent white cataract in which the Argentinian flag sign may be appeared were included in this systematic review. The bibliography was searched from the websites Pubmed, Scopus and Google Scholar. Exclusion criteria were techniques that had not been applied to patients and lacked numerical data on success and complication rates. The bibliography was selected based on relevance and the impact factor of the journals in which the respective studies and articles were published.

The creation of a small capsulorhexis, the aspiration of the liquefied cortex to decompress the lens capsule and, finally, the creation of a 5-mm-diameter caspulorhexis is an effective technique to deal with an incumescent cataract.  Similar technique is the puncture of the anterior lens capsule with an insulin needle and the tipping of the lens nucleus to release the liquefied cortex. Alternative thechniques are the preoperative Nd:YAG laser anterior capsulotomy, the closed-chamber anterior capsulorhexis under air tamponade and the phacocapsulotomy technique. High-end devices such as femtosecond laser and precision pulse caspulotomy device can also be used in order to create a safe caspulorhexis in cases of intumescent cataract.

There are many surgical techniques and preoperative measures that has to be taken in order to prevent the Argentinean flag sign during intumescent cataract surgery. Each of these techniques has its advantages and disandvantages. The answer to this question of which technique should be followed is not that simple. Many factors determines this choice but the most determinant is the experience of the ophthalmic surgeon and his familiarity with each technique.