During capsulorhexis in a patient with a white intumescent cataract, the tear suddenly extends peripherally towards the zonules. What is the primary reason this complication occurs in such eyes?

• A Trypan blue stain weakens the capsule at the site of puncture
• B Zonular fibres are abnormally strong and pull the flap centrally
• C The anterior capsule is thicker than normal in intumescent cataracts
• D Elevated intralenticular pressure converts the shearing force into a radially extending tear ✓

Explanation

In an intumescent cataract the swollen lens raises intralenticular pressure. When the capsulorhexis flap is punctured, this pressure pushes the flap outward, converting the shear force into tension that extends the tear radially, the classic Argentinian flag sign. The anterior capsule is thinner, not thicker, in these eyes, and decompression of milky fluid before completing the rhexis is the accepted preventive step.

Reference: AAO Basic and Clinical Science Course, Section 11: Lens and Cataract, 2023-2024 ed.

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Written and medically reviewed by the StethoPrep medical team.