Sewing Needle Microcapsulotomy To Avert Argentinian Flag Sign

Purpose:

To describe an efficient, safe new device "Sewing Needle Hook", designed with the principle of round pointed tip sewing machine needle to create a round hole puncture at the centre of tense anterior capsule in white mature and intumescent white cataracts to prevent radial anterior capsular tear leading to Argentinian flag sign during capsulorhexis.

The Argentinian flag sign is a known complication in intumescent white cataracts, which arises instantly after an initial prick with a sharp hypodermic needle on a stretched out anterior capsule.  However, it is the ‘linear cut’ configuration of the initial prick, created by the hypodermic needle on the tense anterior capsule, which spontaneously opens up and propagates towards the periphery along its margins. 

It is a prospective interventional study done over a period of 6 months.120 eyes with white intumescent cataract were included in this study. A sewing needle hook is designed with round pointed apex tip. Simply pricking the centre of the white cataract with the pointed round tip create a round hole which doesn't extend peripherally. Central hole helps to evacuate intralenticular fluid and decompress the capsule. All the patients underwent detailed examination. Exclusion criteria were history of coexisting ocular diseases like uncontrolled glaucoma, ocular tumors, ocular trauma, pseudoexfoliation syndrome, zonular dialysis, poorly dilating pupil.

The capsule is stained with 0.06% trypan blue and the anterior chamber completely filled with OVD. Using the main corneal incision, sewing needle hook inserted into anterior chamber and pointed round tip impaled into the capsule and a round hole is created from which intralenticular fluid is evacuated to decrease the intralenticular pressure. Once the fluid is evacuated capsulorrhexis was completed with Utrata forceps. The sewing needle prick prevented Argentinian flag sign in 98.7% eyes out of 120 eyes. Capsulorhexis was completed in 98% of cases.This technique not only ensures the initial decompression, but also prevents a catastrophic Argentinian flag sign.

An intumescent lens puts the surgeon at risk for Argentinian Flag Sign during capsulorhexis. Simultaneous puncture of the anterior capsule with sewing needle hook decompresses the bag preventing an uncontrolled radial extension of tear. In conclusion, sewing needle hook is a successful and reproducible method of achieving a well-sized CCC.