EW CATARACT
84
Device focus
thinking about exactly how—and
how fast—capsular tear-outs as in-
dicated by the Argentinian flag sign
can occur.
The need for speed
I reviewed three cases in which resi-
dents at my hospital had an Argen-
tinian flag sign tear-out, as well as all
the Argentinian flag videos I could
find online (eight total).
For the surgeon, a tear-out feels
like it occurs almost instantly upon
contact with the cystotome.
But with slow-motion video
analysis, I was able to discern that
there is actually some time to po-
tentially prevent this complication.
From the point of contact of the
cystotome to the point at which the
tear reached beyond the margins
of the dilated pupil took 1.87, 2.29,
and more than 4.00 seconds, respec-
tively, in the three cases from our
hospital. The average tear-out time
in the online videos (admittedly not
a scientific sample, since I did not
know what film speed was used or
whether the videos had been edited)
was 2.75 ± 1.08 seconds, with the
fastest observed tear-out occurring at
1.19 seconds.
The longer the femtosecond
capsulotomy takes, the greater the
chance that patient or eye move-
ment could affect it, particularly
with an intumescent cataract that
behaves differently from a sclerot-
ic, age-related cataract. When the
laser interacts with the intumescent
Femtosecond continued from page 83
Argentinian flag sign is an unfortunate complication that can result in additional vitreoretinal
surgery and limited IOL options.
From the point of contact of the cystotome to the point at which the tear reached beyond the
margins of the dilated pupil, the average tear-out time was 2.75 seconds.
Source (all): Timothy P. Page, MD
continued on page 86
