Argentinian flag sign during refractive laser-assisted cataract surgery - A case report.

Purpose: The Argentinian flag sign, or radial capsular tear extensions, is a rare complication when performing capsulorhexis during cataract surgery. Identifying and managing this complication early is important to prevent the tear from propagating around the periphery leading to posterior capsular rupture or vitreous loss. Observations: The Argentinian flag sign was previously reported in a case of femtosecond laser-assisted cataract surgery (FLACS). However, our report presents the first case after FLACS using the Catalys™ Precision Laser System, a platform which has been associated with a larger percentage of complete capsulotomies when compared to other platforms. Radial extensions of the capsular tear were observed in a 27-year-old male patient with an intumescent cataract in left eye. The complication was managed by manually redirecting and completing the radial extension flaps, along with delicate phacoemulsification and manual cutting of capsular edge in areas with significant capsular-IOL overlap. Conclusions and importance: Our case report highlights that despite the Catalys™ Precision Laser System success rates, radial tears may occur, especially in highly pressurized intumescent cataract. Therefore, surgeons must be prepared to optimize the surgical techniques to prevent the occurrence of this complication, as well as identify and manage it when it presents.