Intraoperative Posterior Polar Cortical Disc Defect- A Sign of Intact Posterior Capsule

PURPOSE To describe the incidence and morphological characteristics of posterior polar cortical disc defect (PPCDD) sign observed during phacoemulsification in posterior polar cataract (PPC). SETTING Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India DESIGN:: Prospective case series METHODS:: Sixty-seven eyes of 56 patients with PPC undergoing phacoemulsification were evaluated. Outcome measures were the incidence and characteristics of the intraoperative PPCDD sign, as well as its relation to the intraoperative surgical dynamics and posterior capsule (PC) dehiscence. RESULTS The PPCDD sign was seen in 86.5% eyes (58/67). Amongst these, 93.1% eyes (54/58) showed a complete disc defect, while 6.9% eyes (4/58) had a partial disc defect with incomplete margins. In majority of cases (89.6%; 52/58), the PPCDD sign was seen after epinuclear plate and plaque aspiration. Amongst the 9 eyes which did not show the PPCDD sign, en bloc separation of the plaque and cortical matter from the PC was observed in 2 eyes, the plaque remained adherent to the PC till the end of cortical fiber aspiration in 3 eyes and intraoperative PC rupture (PCR) was observed during the plaque separation in 4 eyes. The incidence of PCR in eyes without PPCDD sign was significantly higher (44.4% vs 0%; P-value <0.001). CONCLUSIONS The visualization of intraoperative PPCDD sign during phacoemulsification in PPC is suggestive of an intact PC and associated with a significantly lower rate of intraoperative PCR as compared with eyes without the PPCDD sign.