Inverse atoll sign as preoperative indicator of posterior capsular defects in posterior lenticonus

Two children with unilateral posterior lenticonus and cataract underwent lens matter aspiration with implantation of a 3-piece intraocular lens. Posterior capsular defect (PCD) was suspected on preoperative slitlamp examination, which was supported by swept-source optical coherence tomography and subsequently confirmed intraoperatively. Based on the findings observed in these 2 cases, an inverse atoll sign for preoperative detection of a PCD is described.