Prevention of Argentinian flag sign in intumescent cataracts using anterior chamber air bubble and cortical fluid release techniques.

BACKGROUND: To investigate the efficiency of a new method for the prevention of argentinian flag sign during the process of continuous, circular, and centered anterior capsulotomy (CCC) on the anterior capsule in cortically liquefied intumescent cataracts. This study was registered in an appropriate registry and the registration number of registration was xyy11[2022]-XJSFX-087; The date of of registration was 2022-04-29. METHODS: Preoperative examinations including slit-lamp examination, ocular A-scan ultrasonography, and Ultrasound Biomicroscopy (UBM) UBM were conducted on 61 patients with intumescent cataracts. Cases with cortically liquefied intumescent cataracts were selected and after staining with indocyanine green, the anterior chamber air bubble technique was used to compress the anterior capsule, and liquefied cortex was aspirated using a puncture needle. Corrected Distance Visual Acuity (CDVA) and intraocular pressure were recorded on postoperative days 1, 1 week, 1 month, and 6 months. Intraoperative and postoperative complications were documented and analyzed. RESULTS: Fifty eyes were identified as having cortically liquefied intumescent cataracts. No cases of the Argentinian flag sign occurred, and standard capsulorrhexis was achieved, facilitating smooth phacoemulsification. All patients achieved satisfactory outcomes at follow-ups of 1 day, 1 week, 1 month, and 6 months postoperatively. Mild corneal edema was observed in three cases on the first postoperative day, with no other complications noted. CONCLUSIONS: The anterior chamber air bubble technique combined with cortical fluid release technique can prevent the occurrence of the Argentinian flag sign in cortically liquefied intumescent cataracts, this method is simple, convenient and economic for the clinical promotion.

Epicapsular Stars in an Asymptomatic Patient.

This case report discusses a diagnosis of epicapsular stars during a routine ophthalmologic examination in an asymptomatic female patient aged 14 years.

New Device for the Correction of Aphakia Without Capsular Support.

PURPOSE: This study describes a prototype developed for aphakia without capsular support (AWCS) and its proof of concept. METHODS: This descriptive study used a 3D software to create and analyze virtual prototypes before manufacturing. A nylon-6/nylon-6.6 copolymer filament and a 3D printer were used for prototyping. A device implantation technique was developed using a 23-gauge hypodermic needle. Two opposing markings, 2 mm posterior to the limbus, were made to determine the location of the scleral punctures and the final position of the device. After adequate centralization and positioning of the device, its haptics were cut and cauterized to generate thermal modeling of the extremity and allow the thickening of the tips (flange), serving as an anchoring mechanism to the sclera. The efficacy and adequacy of the technique and device were then evaluated. RESULTS: Vitreous tissue extrusion was not observed during the sclerotomy. The device was well fixed to the sclera; however, adequate IOL stability and centralization still needed to be achieved. The surgeon evaluated the adequacy of all the other devices' characteristics. CONCLUSIONS: The development of a technology prototype for correcting AWCS was possible. Although the proposed prototype met most of the established concept guidelines, the stability of the IOL position remains challenging.

Angle-closure glaucoma associated with vitreous prolapse after neodymium-doped yttrium-aluminumgarnet laser posterior capsulotomy.

Capsulotomy with neodymium-doped yttriumaluminum-garnet (Nd:YAG) laser is an effective treatment for posterior capsule opacification following cataract surgery. A wide opening of the posterior capsule associated with the ruptured anterior hyaloid can cause anterior chamber vitreous prolapse. Two patients who developed angle-closure glaucoma associated with vitreous prolapse following Nd:YAG laser posterior capsulotomy were successfully treated with antiglaucoma medication and peripheral iridotomies. Patient identification for potential risk factors and a careful postoperative follow-up are essential to avoid these serious complications.

Preventing the Argentinian flag sign and managing anterior capsular tears: A review.

The Argentinian flag sign (AFS) is a feared complication during cataract extraction. Intralenticular pressures, especially excessive posterior pressure, have been identified as potential mechanisms for capsular stress and tearing associated with AFS. Capsular tension is created by positive intralenticular pressures, which cause the irido-lens diaphragm to move anteriorly once the manual capsulorhexis has been initiated. This tension can cause inadvertent tears that self-propagate to the lens equator, causing an AFS, among other intraoperative complications. Thus, this review highlights the importance of identifying intumescent cataracts as well as a combination of techniques to relieve intracapsular pressures needed to prevent AFS. However, some instances of anterior capsular tears are unavoidable. Therefore, focus will also be placed on techniques during cataract extraction used to manage anterior capsular tears, mitigating extension to the posterior capsule.

18-month results of double-fanged 5-0 polypropylene suture transscleral bag fixation in subluxated cataracts.

PURPOSE: To evaluate the stability and efficacy of the double-flanged 5-0 polypropylene suture to fixate subluxated cataracts at 18 months and the possible complications of this new technique. METHODS: This technique uses a 5-0 polypropylene monofilament to create two flanges with a thermocautery, for fixation of a capsular tension segment to the sclera to fix the subluxated capsular bag. This technique was implemented in 17 eyes requiring intraocular lens implantation in a setting of zonular dialysis due to trauma, Marfan syndrome, microspherophakia, idiopathic disease, and post-phacoemulsification status. RESULTS: Follow-up of the patients occurred at 18 months. Best-corrected visual acuity improved significantly from 0.85 to 0.39 (logMAR), whereas the spherical and cylindrical refractive errors and intraocular pressure remained stable from preoperation. No suture photodegradation or pseudophacodonesis were detected. CONCLUSION: The double-flanged 5-0 polypropylene suture transscleral bag fixation technique has shown favorable long-term outcomes in terms of bag intraocular lens/complex fixation and stability. In eyes with zonular weakness or dialysis, this technique appears to be a safe and knotless option for cataract surgery.

Achieving successful capsulorhexis in intumescent white mature cataracts to prevent Argentinian flag sign - A new multifaceted approach to meet the challenge.

Purpose: To present a case series of intumescent white cataract cases managed by a new surgical technique to attain a single stage Continuous Curvilinear Capsulorhexis (CCC). Methods: The series included 60 eyes of 60 patients with white cataract which underwent preoperative anterior chamber depth, lens thickness and ultrasonographic A-scan for intralenticular spikes. A partial size main port (~1.8mm) is created as the first entry into the anterior chamber (AC). A 30-gauge needle of insulin syringe entered through a limbal stab incision is used to decompress the anterior and posterior intralenticular compartments. Following which a standard size, one stage capsulorhexis was performed in a trypan blue stained capsule using microcapsulorhexis forceps entered through the partial sized trapezoidal main port. The main port was secondarily enlarged for phacoemulsification. Results: Based on the intraoperative findings, 43 eyes were categorized as Intumescent type-1 cataracts i.e., with presence of actual liquefied cortex aspirated using 30-gauge needle and 17 eyes as Intumescent type-2 cataracts, i.e., presence of swollen lens without any obvious liquefied cortex. Standard size, circular and centred CCC was achieved in 100% of the cases and no Argentinean flag sign was noted. Surgeon perceived raised intralenticular pressure in 41% of the cases in type-1 subset and 61% cases in type-2 subset (P-0.06). Posterior capsular plaque was observed in 22% of the cases, adherent cortex in 25% and anterior capsular plaque in 5% of the cases. At 6weeks follow up 92% patients had best corrected visual acuity of 20/40 or better. Conclusion: A multi-layered approach can help in attaining successful CCC in cases of white mature cataract with high intralenticular pressure.

Novel double-flanged technique for managing Marfan syndrome and microspherophakia.

A new technique for fixating the capsular bag in patients with ectopia lentis is presented. In this technique, the capsulorhexis is performed using a femtosecond laser, followed by the insertion of a standard capsular tension ring to redistribute capsular forces. The nucleus is hydroprolapsed into the anterior chamber and nuclear disassembly is performed above the iris plane to reduce zonular stress. Finally, a 5-0 polypropylene monofilament is used to fixate a capsular tension segment and subluxated capsular bag. This novel double-flanged method, achieved with cautery, does not require direct suturing of the monofilament on the sclera. This article describes the use of this new technique in 3 eyes, 2 in patients with Marfan syndrome and 1 in a patient with microspherophakia.

A case of late-onset capsular block syndrome and its surgical treatment / Um caso de síndrome de bloqueio capsular tardio e uma abordagem cirúrgica

ABSTRACT - Capsular block syndrome is a rare complication of phacoemulsification surgery with continuous curvilinear capsulorhexis and intraocular lens implantation. Here, we report a case of very late-onset capsular block syndrome that developed 13 years after cataract extraction and present the surgical approach used for its successful treatment.

RESUMO - Síndrome do bloqueio capsular é uma complicação incomum da cirurgia de facoemulsificação com capsulorrexis curvilínea contínua e implante de lente intraocular. Nós relatamos um caso de síndrome de bloqueio capsular de início tardio que se desenvolveu após 13 anos da extração da catarata e apresenta a abordagem cirúrgica utilizada para o sucesso do tratamento.

A case of late-onset capsular block syndrome and its surgical treatment.

Capsular block syndrome is a rare complication of phacoemulsification surgery with continuous curvilinear capsulorhexis and intraocular lens implantation. Here, we report a case of very late-onset capsular block syndrome that developed 13 years after cataract extraction and present the surgical approach used for its successful treatment.

A multipronged approach to prevent Argentinian flag sign in intumescent cataracts.

In this communication, we describe a technique for creation of a single stage, adequately sized capsulorrhexis in intumescent cataracts by depressurizing the anterior and posterior intralenticular compartments in a nonleaky anterior chamber (AC) to prevent capsulorrhexis extension and Argentina flag sign. Initially, an incomplete main-port incision is made by the partial entry of a 2.2-mm keratome. A cohesive dispersive ophthalmic viscosurgical device (OVD) is injected into AC. Standard side-port incisions are made, followed by anterior capsular staining. The fluid cortex in anterior intralenticular compartment is aspirated by puncturing anterior capsule in the center using a 30-gauge needle entered through a separate limbal stab incision. The nucleus edge is gently tipped posteriorly with the needle tip to release the fluid from posterior intralenticular compartment also and as much fluid aspirated as possible. OVD is again injected and capsulorrhexis is performed in a single stage using micro-capsulorrhexis forceps.

Double-flanged-haptic and capsular tension ring or segment for sutureless fixation in zonular instability.

PURPOSE: This paper introduces a surgical technique for the sutureless management of zonular dialysis greater than 120° using a capsular tension segment (CTS) or a modified capsular tension ring (m-CTR; CTR with suturing eyelets) and a haptic removed from a 3-piece polypropylene IOL. METHODS: A CTR is used as normal. Cataract removal is followed by connection of the CTS or m-CTR to the single haptic and created using heat to make a flange in one haptic's extremity. The other extremity is placed in the CTS or m-CTR's central hole. The CTS or m-CTR/flanged-haptic complex is introduced into the capsular bag and aligned with the weakest zonular quadrant. A 30-gauge needle guides the externalization of the free haptic extremity through the adjacent pars plana and creates a flange on the second haptic tip permitting intrascleral fixation of the CTS or m-CTR. RESULTS: The result is a successful IOL implantation with a sutureless technique. CONCLUSIONS: This double-flanged m-CTR/CTS technique allows suture-free option for managing zonular weakness or dialysis while performing cataract surgery.

Síndrome do bloqueio capsular tardio - relato de dois casos / Capsular block syndrome - report of two cases

Relato de dois casos de síndrome do bloqueio capsular, de ocorrência tardia, nove e cinco anos após facoemulsificação, respectivamente, em um olho com pseudoexfoliação capsular e outro operado de glaucoma, com bolha funcionante. A condição se constituiu na retenção de grande quantidade de líquido esbranquiçado, atrás da lente intraocular, o que levou à redução da AV, de quatro linhas de Snellen, nos dois casos. Houve pronta resolução do quadro com mínima capsulotomia posterior.

Two cases of late capsular block syndrome are reported. They were observed nine and five years after facoemulsification, in one eye with pseudoexfoliation syndrome and the other operated on for glaucoma with a functioning bleb. There was a large amount of milky material behind the intraocular lens, and reduction of the visual acuity (four lines of the Snellen chart in both cases). The condition was promptly resolved through minimal YAG laser posterior capsulotomy.

Capsulorrexe em duplo anel: estudo clínico patológico / Double ring capsulorhexis: clinic opathologic study

Apresentamos caso de capsulorrexe em duplo anel em paciente feminina de 81 anos. O espécime cirúrgico foi submetido a estudo anatomopatológico que evidenciou os achados típicos da capsulorrexe em duplo anel. Comentamos a possível relação com a exfoliação capsular verdadeira. Salientamos que é possível realizar a cirurgia com bom resultado mesmo que o duplo anel não seja completo - como no caso apresentado - , porém desde que os folhetos capsulares estejam fundidos de forma contínua.

We present a case of double ring capsulorhexis in a 81 year-old female patient. Surgical specimen was submitted to histopathologic study resulting in typical double ring capsulorhexis findings. We discuss the questioned relation to true capsular exfoliation. We call attention to the fact that it is possible to obtain a good surgical result even when the double ring is not complete - as the case presented - , since both capsular flaps are fused in a continuous form.

Intraocular lens iris fixation. Clinical and macular OCT outcomes.

BACKGROUND: To assess the efficacy, clinical outcomes, visual acuity (VA), incidence of adverse effects, and complications of peripheral iris fixation of 3-piece acrylic IOLs in eyes lacking capsular support. Thirteen patients who underwent implantation and peripheral iris fixation of a 3-piece foldable acrylic PC IOL for aphakia in the absence of capsular support were followed after surgery. Clinical outcomes and macular SD-OCT (Cirrus OCT; Carl Zeiss Meditec, Germany) were analyzed. FINDINGS: The final CDVA was 20/40 or better in 8 eyes (62%), 20/60 or better in 12 eyes (92%), and one case of 20/80 due to corneal astigmatism and mild persistent edema. No intraoperative complications were reported. There were seven cases of medically controlled ocular hypertension after surgery due to the presence of viscoelastic in the AC. There were no cases of cystoid macular edema, chronic iridocyclitis, IOL subluxation, pigment dispersion, or glaucoma. Macular edema did not develop in any case by means of SD-OCT. CONCLUSIONS: We think that this technique for iris suture fixation provides safe and effective results. Patients had substantial improvements in UDVA and CDVA. This surgical strategy may be individualized however; age, cornea status, angle structures, iris anatomy, and glaucoma are important considerations in selecting candidates for an appropriate IOL fixation method.

Complicaciones de la capsulotomía posterior por láser de Nd-Yag en el Centro Oftalmológico Enrique Cabrera de La Habana / Complications of posterior capsulotomy due to Nd-Yag laser in Enrique Cabrera Ophthalmological Center from Havana

Introducción: la opacidad capsular posterior es la complicación más frecuente de la cirugía de catarata y, aunque la capsulotomía con láser de Nd-Yag es un procedimiento muy efectivo para solucionarla, no está exenta de complicaciones. Objetivo: describir las complicaciones en pacientes expuestos a capsulotomía con láser de Nd-Yag. Métodos: se realizó un estudio descriptivo y prospectivo de 104 pacientes con opacidad capsular posterior, atendidos en el Centro Oftalmológico Enrique Cabrera de la Habana, durante el 2010. Se analizaron las variables frecuencia y tipo de complicaciones, edad, sexo, antecedentes patológicos personales oculares y sistémicos, clasificación de la opacidad capsular, energía utilizada, así como agudeza visual antes y después del tratamiento. Resultados: en la casuística predominaron el aumento de la presión intraocular y el edema macular quístico como las complicaciones más comunes, los pacientes de 56-75 años, el sexo femenino, así como la opacidad capsular fibrótica y la capsulotomía con más de 8,0 MJ. Conclusiones: más de la mitad de los afectados presentaron complicaciones de carácter transitorio y reversible, las cuales no estuvieron relacionadas con la cantidad de energía empleada; la mejoría visual después del proceder fue notable(AU)

Introduction: the posterior capsular opacity is the most frequent complication in the cataract surgery and, although capsulotomy with Nd-Yag laser is a very effective procedure to solve it, it is not free of complications.Objective: to describe the complications in patients exposed to capsulotomy with Nd-Yag laser. Methods: a descriptive and prospective study of 104 patients with posterior capsular opacity, assisted in Enrique Cabrera Ophthalmological Center from Havana, was carried out during the 2010. Variables of frequency and type of complication, age, sex, pathological ocular and systemic medical history, classification of the capsular opacity, energy used, as well as visual acuity before and after the treatment were analyzed. Results: the increase of the intraocular pressure and the cystic macular edema as the most common complications, the 56-75 year-old patients, female sex, as well as the capsular fibrotic opacity and the capsulotomy with more than 8,0 MJ prevailed in the case material.Conclusions: more than half of the patients presented complications of transitory and reversible type, which were not related to the quantity of energy used; the visual improvement after the procedure was remarkable(AU)

Trasplante autólogo de células límbicas y recubrimiento con membrana amniótica / Limbic cell autologous transplantation and coating with amniotic membrane

Se trata de una paciente con antecedentes de quemadura corneal en el ojo izquierdo desde hacía un trienio, a quien además de haberle realizado una queratoplastia terapéutica, la extracción extracapsular del cristalino y la colocación de una lente intraocular un año después, evolucionó con insuficiencia de células límbicas, conjuntivalización de la córnea y simbléfaron. Luego de un trasplante autólogo de las mencionadas células y recubrimiento con membrana amniótica (primer caso informado en la provincia), mejoró considerablemente a los 6 meses de seguimiento clínico, después de lo cual se le realizó una queratoplastia penetrante con finalidad óptica(AU)

This is a patient with history of cornea burn in the left eye for three years. After having performed a therapeutic keratoplasty, extracapsular lens extraction and intraocular lens implantation a year later she progressed with limbic cell failure, cornea conjunctivalization and symblepharon. Once autologous transplantation of these cells and coating with amniotic membrane (first case informed in the province) were performed, the patient improved significantly at 6 months of clinical follow-up, after which she underwent penetrating keratoplasty with optical purposes(AU)

Trasplante autólogo de células límbicas y recubrimiento con membrana amniótica / Limbic cell autologous transplantation and coating with amniotic membrane

Se trata de una paciente con antecedentes de quemadura corneal en el ojo izquierdo desde hacía un trienio, a quien además de haberle realizado una queratoplastia terapéutica, la extracción extracapsular del cristalino y la colocación de una lente intraocular un año después, evolucionó con insuficiencia de células límbicas, conjuntivalización de la córnea y simbléfaron. Luego de un trasplante autólogo de las mencionadas células y recubrimiento con membrana amniótica (primer caso informado en la provincia), mejoró considerablemente a los 6 meses de seguimiento clínico, después de lo cual se le realizó una queratoplastia penetrante con finalidad óptica.

This is a patient with history of cornea burn in the left eye for three years. After having performed a therapeutic keratoplasty, extracapsular lens extraction and intraocular lens implantation a year later she progressed with limbic cell failure, cornea conjunctivalization and symblepharon. Once autologous transplantation of these cells and coating with amniotic membrane (first case informed in the province) were performed, the patient improved significantly at 6 months of clinical follow-up, after which she underwent penetrating keratoplasty with optical purposes.