Posterior argentinean flag-like sign during primary posterior continuous curvilinear capsulorhexis

ABSTRACT We describe a unique complication during primary posterior continuous curvilinear capsulorhexis (PCCC) in a patient with megalocornea scheduled for phacoemulsification with toric multifocal intraocular lens (IOL) implantation. After nucleus emulsification and cortex removal, the capsular bag was filled with cohesive viscoelastic in preparation for PCCC to achieve reverse optic capture of the IOL, thus ensuring stability. However, as soon as the initial puncture was made using a 27-gauge needle to start the capsulotomy, the posterior capsule opening extended peripherally from 0º-180º. This capsule extension was similar to the Argentinean-flag sign in hypermature cataracts, and both are caused by excessive intracapsular pressure. Careful bimanual manipulation was performed to implant the IOL on the desired axis, which occurred uneventfully. At a postoperative visit, the patient exhibited excellent uncorrected visual acuity with a well-aligned IOL.

摘要 本文报道1例合并大角膜（megalocornea）的患者，拟行超声乳化术（phacoemulsification）联合散光多焦点人工晶状体（toric multifocal intraocular lens，IOL）植入术时，原发性后房型连续环形撕囊（primary posterior continuous curvilinear capsulorhexis，PCCC）术中出现罕见并发症。在完成晶状体核乳化及皮质吸出后，术者向晶状体囊袋内注入粘性黏弹剂（cohesive viscoelastic）以准备行PCCC，通过实现人工晶状体光学部反包绕以确保其稳定性。然而，当使用27号针头（27-gauge needle）行初始穿刺以开始囊膜切开时，后囊膜开口从0°至180°方向周边扩展。该囊膜扩展现象与过熟期白内障（hypermature cataracts）中的阿根廷旗征（Argentinean-flag sign）表现相似，二者均由过高的囊内压力所致。术者随后采用精细的双手操作技术（bimanual manipulation），将人工晶状体精准植入预定轴位，手术过程顺利。术后随访时，患者裸眼视力（uncorrected visual acuity）优异，人工晶状体对位良好。