Argentina's Flag- Phaco in an Intumescent Mature Cataract (Managing a Run-Out Rhexis)

1. Manish Mahendra
2. Youraj Mahendra
3. Shally Mahendra

Khairabad Eye Hospital, Kanpur, India

Purpose: To show the surgical management of a run-out rhexis in a case of an intumescent mature cataract and steps to avoid it.

Methods: 1. Avoid creating outer and inner tension on the lens. 2. Stain the capsule with trypan blue. 3. Puncture and aspirate the liquified cortex to decrease intralenticular pressure. 4. Management of the torn rhexis. Spontaneous tear in the capsule extends into the periphery and mimics the blue-white-blue arrangement of the Argentina flag. Modified rhexis is performed. Phaco chopping is the most appropriate technique applied.Supracapsular phacoemulsification is done to avoid stressful cracking.Bottle height is lowered,flow rate is reduced and vacuum is decreased.IOL implantation is done in the bag placing the haptics perpendicular to the tear.

Results: By applying modified techniques one can manage these intumescent mature cataracts and do successful phacoemulsification.

Conclusions: Pre-surgical evaluation,careful surgical planning,skillful and dilligent surgical technique can prevent complications in these cataracts