Peripheral capsulorhexis – A novel technique to prevent Argentinian flag sign in intumescent white cataracts

The most challenging step in handling an intumescent cataract is the creation of a well-sized, round, centered, continuous, and curvilinear capsulorhexis. Due to high intralenticular pressure, the capsulorhexis tear has high tendency to extend equatorially leading to development of Argentinian flag sign. To overcome this, we describe a novel technique of capsulorhexis for intumescent white cataracts that does not need special instrumentation. Antero-posterior diameter of lens is more in the center due to its biconvex configuration. This leads to more intralenticular fluid accumulation and thus comparatively higher intralenticular pressure in the center. Thus, it was decided not to touch central, tense, bulging capsule, and initiate capsulorhexis in the periphery. Two perimetric flaps were created, sheared circumferentially, and joined midway resulting in a complete circular capsulorhexis. This minimized the tendency of capsulorhexis runway to the periphery and allowed one-stage creation of a well-sized capsular opening for phacoemulsification.