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Related Experiment Video

Updated: Jan 9, 2026

A Novel Technique of Rescuing Capsulorhexis Radial Tear-out using a Cystotome
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Flutter Sign - An Indicator of Intact Anterior Hyaloid Face After Posterior Capsule Rupture During

Rohit Om Parkash1, Tushya Om Parkash1, Trupti Sharma2

  • 1Department of Cataract Surgery, Dr Om Parkash Eye Institute, Amritsar, Punjab, India.

Clinical Ophthalmology (Auckland, N.Z.)
|December 2, 2025
PubMed
Summary

The intraoperative Flutter Sign indicates anterior hyaloid face integrity after posterior capsule tears during cataract surgery. Fluttering edges suggest intactness, while static edges signal vitreous prolapse and potential complications.

Keywords:
Flutter Signanterior hyaloid facecataract extractionintraoperative complicationsphacoemulsificationposterior capsule tearvitreous body

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Area of Science:

  • Ophthalmology
  • Surgical Techniques
  • Anterior Segment Surgery

Background:

  • Posterior capsule tears (PCT) can occur during phacoemulsification, potentially leading to vitreous prolapse and complications.
  • Assessing anterior hyaloid face (AHF) integrity in real-time is crucial for managing PCT.
  • Current methods for assessing AHF integrity may be limited or invasive.

Purpose of the Study:

  • To describe and validate the intraoperative Flutter Sign as a real-time indicator of AHF integrity following PCT.
  • To correlate Flutter Sign characteristics with AHF status, vitreous prolapse, and surgical outcomes.

Main Methods:

  • A single-centre observational study combining retrospective (12 PCT cases) and prospective (8 PCT cases) evaluations.
  • Analysis of surgical videos for PCT edge morphology and motility.
  • Intraoperative assessment of AHF integrity and vitreous status.

Main Results:

  • Sharp, fluttering PCT edges correlated with intact AHF, no vitreous prolapse, and excellent visual acuity (20/20).
  • Scalloped, non-fluttering edges indicated AHF rupture and vitreous prolapse, often requiring anterior vitrectomy and sulcus-fixated IOLs.
  • Complications included lens material migration and transient IOP elevation in the non-fluttering edge group.

Conclusions:

  • The Flutter Sign is a simple, dye-free, real-time indicator of AHF integrity post-PCT.
  • Fluttering edges signify intact AHF, while scalloped static edges indicate vitreous prolapse.
  • This sign aids in immediate surgical decision-making following posterior capsule tears.