Ocular findings Ocular finding Microcephalic Normocephalic percentage (N) percentage (N) Double Ring Sign
0% (0) 11% (9) Optic Nerve Anomalies * 25% (3) 7% (6) Retinal anomalies ** 25% (3) 12% (10) Blunted Foveal Reflex 0% (0) 1% (1) * Optic nerve: small, oval or tilted, ** Retina: mottling, macular stippling, retinopathy Table 2.
Keywords: True exfoliation, Capsule, Cataract, Phacoemulsification, Double ring sign.
We report a rare case of per operative unilateral spontaneous idiopathic splitting of the anterior lens capsule signified by the double ring sign which eventually lead to a spontaneous and complete separation of the superficial lamina of the anterior capsule (true exfoliation) in a 45 year old female.
As the capsulorhexis was performed the surgeon noted a double ring sign signifying the splitting of the anterior capsule into a superficial and deep lamina.
The hall mark of splitting of the anterior capsule during lens surgery is the appearance of double ring sign on the anterior capsule during capsulorhexis.4
Cases of development of spontaneous double ring sign without complete separation of anterior lamina5 as well as post-operative spontaneous true exfoliation have been reported.6 Our patient had an initial double ring sign, signifying a split in the anterior capsule, but unlike all other reported cases went on to develop a per-operative spontaneous and complete separation of the superficial lamina which is consistent with true exfoliation.
Abnormal findings were seen in 32 of the patients evaluated, which findings included double ring sign (Figure 1) in 8% of the patients, macular stippling in 8%, intraretinal hemorrhage in 6%, small optic nerve (Figure 1) in 5%, distal peripheral perivascular hemorrhage in 2%, and mottling (Figure 2) in 3%.
Ocular finding Microcephalic Normocephalic (N = 12) (N = 83) Double Ring Sign 0% (0) 11% (9) Small Optic Nerve 25% (3) 4% (3) Macular Stippling 8% (1) 8% (7) Mottling 0% (0) 4% (3) Retinopathy of Prematurity Stage 1, Zone III 17% (2) 0% (0) Oval Optic Nerve 0% (0) 2% (2) Tilted Nerve 0% (0) 1% (1) Blunted Foveal Reflex 0% (0) 1% (1)