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PHOTO ESSAY
Year : 2022  |  Volume : 2  |  Issue : 2  |  Page : 569-570

Demonstration of the sinking cortex sign - Pre-existing posterior capsule rupture in mature traumatic cataract


Department of Cataract and IOL, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India

Date of Submission11-Jul-2021
Date of Acceptance11-Sep-2021
Date of Web Publication13-Apr-2022

Correspondence Address:
Bala Saraswathy
Department of Cataract and IOL, Aravind Eye Hospital, Coimbatore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1868_21

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  Abstract 


Keywords: Blunt trauma, posterior capsule dehiscence, sinking cortex sign


How to cite this article:
Priya A, Saraswathy B, Narendran K. Demonstration of the sinking cortex sign - Pre-existing posterior capsule rupture in mature traumatic cataract. Indian J Ophthalmol Case Rep 2022;2:569-70

How to cite this URL:
Priya A, Saraswathy B, Narendran K. Demonstration of the sinking cortex sign - Pre-existing posterior capsule rupture in mature traumatic cataract. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 May 26];2:569-70. Available from: https://www.ijoreports.in/text.asp?2022/2/2/569/342906



A 32-year-old male patient presented with a history of injury in the left eye with an iron wire of 1-week duration and progressive decrease in vision associated with intermittent pain. On examination, his vision was 1/60. Slit-lamp examination showed circumcorneal congestion, mild anterior chamber reaction, white mature cataract with intact anterior capsule, and “sinking cortex” sign [Figure 1] and posterior synchiae between 12 and 3 clock hour positions. Intraocular pressure was normal. B scan ultrasonography showed floating vitreous echoes of moderate density [Figure 2]. The other eye Anterior and posterior segment was normal within normal limits. “Sinking cortex” sign anticipated us posterior capsule dehiscence. He underwent cataract extraction, and intraoperatively after cataract extraction, we appreciated posterior capsule dehiscence at the same site with vitreous disturbances. We performed anterior vitrectomy, and a multipiece intraocular lens was placed in the sulcus. Postoperative Day 1 [Figure 3], vision improved to 6/24, and he was advised tapering dose of steroids, antibiotics, and oral antibiotics with topical nonsteroidal anti-inflammatory drugs for 1 month. After 1 month, his best-corrected visual acuity was 6/6p.
Figure 1: Slit lamp examination-inside black box showing a dimple in the anterior cortex of the cataract-æsinking cortex signæ

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Figure 2: B- Scan ultrasonography showing floating vitreous echoes of moderate density

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Figure 3: Postoperative day 1 same site showing posterior capsule dehiscence

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  Discussion Top


Posterior capsular rent in traumatic cataracts is one of the common complications.[1] Diagnosing preexisting posterior capsule dehiscence in case of traumatic mature cataracts on slit-lamp examination is a challenging task. The hallmark of identifying posterior capsule defect in traumatic mature cataracts is by “sinking cortex” sign.[2] As a result of the defect in the posterior capsule, the posterior cortex sinks behind in the vitreous cavity. Moreover, there is always some absorption of the lens matter. All these together will create an empty space in between the intact anterior capsule and the anterior cortex. This empty space appears as a dimple in the anterior cortex of the cataract, which we call the “sinking cortex” sign[1] [Figure 2]. Traumatic mature cataract, the “sinking cortex” sign, and floating echoes in the B scan are a sure indication of preexisting posterior capsule defect. In case of blunt trauma, posterior capsule defect is usually located in the central part of the posterior capsule as it is the thinnest area and most vulnerable to concussion insult.[3]

In summary, this case emphasizes the importance of the “sinking cortex” sign in predicting posterior capsule dehiscence in traumatic mature cataracts for a suitable surgical strategy and to achieve satisfactory technical and visual outcomes.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kymionis GD, Diakonis VF, Liakopoulos DA, Tsoulnaras KI, Klados NE, Pallikaris IG. Anterior segment optical coherence tomography for demonstrating posterior capsular rent in posterior polar cataract. Clin Ophthalmol 2014;8:215-7.  Back to cited text no. 1
    
2.
Nanavaty MA, Mehta PA, Raj SM, Vasavada AR. Diagnosis of pre-existing posterior capsule defect in traumatic white mature cataract with intact anterior capsule. Eye (Lond) 2006;20:949-51.  Back to cited text no. 2
    
3.
Angra SK, Vajpayee RB, Titiyal JS, Sharma YR, Sandramouli S, Kishore K, et al. Types of posterior capsular breaks and their surgical implications. Ophthalmic Surg 1991;22:388-91.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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