Puncturing the anterior capsule in the anterior chamber so that the pressure falls below intracapsular tension causes the rhexis to extend out to the equator. If this develops into a tear that wraps around the entire lens it is called the Argentinian flag sign. A heavy molecular weight ophthalmic viscosurgical devices (OVD) can ensure the anterior chamber pressure is maintained above intracapsular pressure. Femto-second laser is a method to complete capsulotomy with minimal / no risk of tear out. The authors describe a simple technique of inserting Healon GV or Healon 5 through a small side port incision 21-gauge 0.8mm side port incision until flattening of the anterior capsule is observed indicating that anterior chamber is greater than intracapsular pressure. The central capsule is cut with forceps tip and rhexis completed without exiting the anterior chamber until rhexis is complete, the rhexis is sized so that it plugs the incision and OVD cannot flow out of the anterior chamber. This technique is also supposed to prevent the outflow of liquefied milky cortex. It also avoids having to aspirate liquified cortex but doesn’t allow maintaining anterior chamber pressure. 

Simple approach to prevent capsule tear-out during capsulorhexis creation in hyper mature cataracts.
Robinson MS, Olson RJ.
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Sharmina Khan

Moorfields Eye Hospital, London, UK

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