Assessing the validity of flap motility sign in predicting the extent of anterior capsular tears in phacoemulsification

• Published in: Indian journal of ophthalmology Vol. 71; no. 8; pp. 3095 - 3099
• Main Authors: Parkash, Rohit, Gurnani, Bharat, Kaur, Kirandeep, Parkash, Tushya, Sharma, Trupti
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01-08-2023; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer - Medknow; Wolters Kluwer Medknow Publications
• Subjects: anterior capsular tears; argentinian flag sign; Cataract; Cataracts; Complications; Complications and side effects; Eye surgery; flap motility sign; Flaps (Surgery); Intraocular lenses; iol implantation; Methods; Motility; Patient monitoring; Phacoemulsification; posterior capsule rupture; Surgery; Surgical Technique; Tears; India; posterior capsule rupture; IOL implantation; Anterior capsular tears; Argentinian flag sign; flap motility sign
• ISSN: 0301-4738; 1998-3689
• DOI: 10.4103/IJO.IJO_2552_22

Capsulorhexis is an integral step of cataract surgery, and continuous curvilinear capsulorhexis is crucial during phacoemulsification to prevent intraoperative complications. However, sometimes during phacoemulsification in complicated and hard cataract cases, rhexis extension may occur, resulting in posterior capsular rent, nucleus drop, cortex drop, and aphakia. It may not always be possible to continue with phacoemulsification in all cases. In this perspective, the authors describe a novel flap motility sign (FMS) to predict the extent of anterior capsular tear during phacoemulsification. A total of 21,678 patients underwent phacoemulsification for three years, from July 2016 to June 2019. One hundred and twenty-one patients had an anterior capsular tear. There were 102 cases (84.3%) with pre-equatorial tears and 19 cases (15.70%) with postequatorial tears. All pre-equatorial flaps were everted and fluttering, and all postequatorial flaps were inverted and nonfluttering. Posterior capsule rupture (PCR) was observed in all 19 cases of postequatorial flaps (100%). No PCR was observed in patients with fluttering and everted flaps (0%). In-the-bag and scleral-fixated intraocular lens implantations succeeded in pre-equatorial and postequatorial tears, respectively. There was no case of a nucleus drop. This study validates FMS as a predictor for identifying the extent of anterior capsular tears, thereby determining the endpoint of safe phacoemulsification and the site for intraocular lens implantation. Pre-equatorial tears allow for the continuation of safe phacoemulsification and in-the-bag intraocular implantation. Postequatorial tears necessitate timely conversion to small-incision cataract surgery or extracapsular cataract extraction.