Argentinean Flag Sign (AFS): Reassessing how it actually works, and its management

Author Block: Steve A. Arshinoff . University of Toronto.
 

Author Disclosure Block: Steve Arshinoff:    S.A. Arshinoff:   Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Alcon, Zeiss, Rayner, Cima, Arctic Dx. Any direct financial payments including receipt of honoraria; Description of relationship(s); consultant.
 

Abstract Body: 

Purpose: To review the literature and physics of AFS trying to determine the physics
of AFS, and thereby its optimal solutions. 

Study Design: Review of literature and videos on AFS and subsequent application of the physics of what actually happens. 

Methods: Papers and videos, beginning with the original description of AFS by Perrone and Albertazzi in 2001, and the various descriptions of management techniques since then, including looking at failures and why they occur,
were reviewed. The principles of physics and how they apply to a fluid lens were applied to achieve
a solution.

 Results: AFS really is only at high risk of occurrence when the lens capsule and adjacent
cortex become necrotic in white cataracts. The capsule loses its elasticity and strength, and the lens
contents effectively act as a liquid permitting transmission of posterior forces anteriorly. Once the
capsule is perforated, the transmitted posterior force encourages the weakened capsule to tear
outwardly. Solutions to AFS must deal with the physical reality of this to work for every case.
 

Conclusions: AFS really occurs because of a change in the physical nature of the lens and its
capsule. Surgical management can easily be designed to overcome this change, once its real cause
and nature are recognized.