© 2017 Om Parkash et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Clinical Ophthalmology 2017:11 1445–1451 Clinical Ophthalmology Dovepress submit your manuscript | www.dovepress.com Dovepress 1445 Original researCh open access to scientific and medical research Open access Full Text article http://dx.doi.org/10.2147/OPTH.S136532 Flap motility as a sign of posterior capsule rupture in peripherally extended anterior capsular tears rohit Om Pa rkash 1 shruti Mahajan 2 Vinod Biala 3 Tushya Om Parkash 4 alhaj F Tasneem 5 1 Department of Cataract surgery, 2 Department of Cataract and ref ractive surgery, Dr Om Parkash eye inst itute, amritsar, 3 Department of Cataract surgery, eye Care Centre, ghaziabad, 4 Department of Cataract and ref ractive surgery, 5 Department of Ophthalmology, Vydehi inst itute of Medical sciences and research Centre, Bangalore, india Purpose: To describe various types of anterior capsular tears and an early diagnostic, flap motility, as a sign of posterior capsular rupture following posterior extension of radial tears. Design: This was a prospective study carried out in 4,331 eyes that underwent phacoemulsifi- cation in a private practice setting from April 2015 to February 2016. Twenty six consecutive cases of anterior capsular tears were included. Morphological features of anterior capsular tears and resultant complications were evaluated. Parameters studied were surgical step during which the tear occurred, shape of tear, its extension in relation to the equator, and flap nature and motility in tear extending up to equator. Main outcome measures: The main outcome measures were motility and nature of flaps in anterior capsular radial tears and the relation to posterior capsule rupture. Results: Based on shape, extent, and angulation, anterior capsular tears were categorized into 5 types: Type I, pre-equatorial radial tear (26.92%); Type II, post-equatorial radial tear (3.85%); Type III, Argentinean flag sign pre-equatorial tear (57.69%); Type IV, Argentinean flag sign post-equatorial tear (7.69%), and Type V, mini punch (3.85%). Flaps were either seen to be everted and fluttering or inverted and non-fluttering. In all cases with everted fluttering flaps no posterior capsular rupture (PCR) was observed, while in cases with inverted non-fluttering flaps a PCR was observed (p,0.05). Conclusion: Everted and fluttering flaps of the anterior capsular tears indicate pre-equatorial tear, while inverted and non-fluttering flaps indicate posterior capsule rupture following tear extension beyond the equator. Keywords: anterior capsule tear, posterior capsule rupture, flap motility sign, earliest sign Introduction Radial tears in capsulorhexis margin are not an uncommon complication and can occur during any stage of phacoemulsification surgery. 1 Once a tear occurs in the capsulorhexis margin, it can easily extend to the equator and sometimes beyond it due to the irrigating fluid and the inter-capsular pressure created by lens material. If it extends to the posterior capsule causing a posterior capsule rent (PCR), then the surgery can get complicated by vitreous loss or nucleus drop. 2 At present, there is no known intraoperative clue that can ascertain the extent of intraoperative radial tear of the capsulorhexis margin. Consequently, the surgeon remains in a dilemma whether to continue or abort phacoemulsification. In the present study, we describe various types of anterior capsular tears and for the first time an intraoperative sign, flap motility, that can help to ascertain the extent of the anterior capsular tear in relation to lens equator. Correspondence: shruti Mahajan Dr Om Parkash eye institute, 117-a, The Mall, amritsar, Punjab 143001, india Tel +91 75 0858 5399 email shrutim84@gmail.com Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: http://youtu.be/SKT6KIgk-mw Video abstract