Argentina Flag Sign? CCC Continuous Curvilinear Capsulorrhexis complication cataract surgery

👁 What is CCC (Continuous Curvilinear Capsulorrhexis)?

• Introduced by Gimbel and Neuhann in 1984
• A key step in cataract surgery
• Creates a smooth circular opening (5–5.5 mm) in the anterior lens capsule
• Prevents radial tears during phaco or IOL insertion

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🌀 What is the Argentina Flag Sign?

• A rapid bilateral radial tear of the anterior capsule
• Named for its resemblance to the Argentinian flag
• Often occurs when intralenticular pressure is high
• First described by Daniel M. Perrone in 2000

 

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📸 Features & Risk

• Happens during CCC
• More likely when capsule visibility is poor
• Trypan blue helps visualize the capsule
• Progression is fast and unpredictable

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🛡️ Prevention Strategies

1. Pre-op Mannitol IV to reduce posterior pressure
2. Use of highly cohesive OVDs to maintain anterior chamber depth
3. Two-stage CCC:
   • Start small
   • Use bimanual I&A to decompress lens
   • Then complete CCC
4. Phaco capsulotomy may be an alternative

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✅ Summary

• CCC is essential for safe cataract surgery
• Argentina Flag Sign is a serious complication that must be anticipated
• Proper visualization, pressure control, and technique are crucial
• Even in laser-assisted cataract surgery, CCC accuracy remains vital