Anterior capsule staining using 0.025% trypan blue in cataracts without red reflex

Abstract

Purpose:To describe the use of anterior capsule staining in cataracts without red reflex using a 0.025% trypan blue solution. Methods: Six eyes of 6 patients with cataracts without red reflex were submitted to phacoemulsification using a direct injection of 0.2 to 0.5 ml of 0.025% trypan blue in the anterior chamber previous to viscoelastic injection. All patients had an ophthalmologic examination prior to surgery, as well as pre and postoperative corneal endothelial cell count. Results: In all cases the capsule became stained with a faint blue color that enabled an adequate visibility of the flap during the continuous curvilinear anterior capsulotomy (CCC). There were no intra-or postoperative complications. The endothelial cell loss varied between 1.8% and 26.6% (mean 12.8%). Conclusion: Staining the anterior capsule with 0.025% trypan blue solution allows a good visibility of the capsular flap and facilitates the confection of CCC in cataracts without red reflex. Uso de azul tripano a 0,025% para corar a cápsula anterior em catarata sem reflexoEsse trabalho foi realizado no

Efficacy of a lutein-based dye (PhacodyneTM) for visualizing anterior capsulorhexis during cataract surgery by phacoemulsification

“…Good visualization of the anterior capsule flap is needed when performing the CCC, particularly in the absence of a red reflex (2)(3)(4) . Since the lack of a red reflex results in technical difficulties (2)(3)(4) , a correct CCC is useful when a more aggressive manipulation of the capsular bag is required (3) . In such clinical conditions, the improvement of the anterior capsule visualization can also be of great value for surgeons, particularly for those who are learning the surgical technique (4) .…”

Effects of intracameral brilliant blue on the corneal endothelium of swine: in vitro study

“…The use of vital dyes in ophthalmology to facilitate CCC is actually indicated in white cataracts without fundus reflex (Marback et al 2001). The CCC technique can be used in planned extracapsular cataract extraction and in phacoemulsification to reduce the risks of tearing during nucleus and cortex removal and intraocular lens implantation.…”

“…In this research, the use of the brilliant blue intracameral dye without another substance or air bubble was done to produce direct contacts between the vital dye and the corneal endothelium. The vital dyes that have been used to stain the anterior lens capsule are trypan blue, fluorescein, green indocyanine, violet gentian, autologous blood and brilliant blue (Melles et al 1999, Pandey et al 2000, Ünlü et al 2000, Yetik et al 2002, Chang et al 2005) although some of them are not considered safe or effective (Pandey et al 2000, Marback et al 2001. Trypan blue and green indocyanine selectively stain dead endothelial cells and because the endothelial cells are alive in cataract surgery they do not obstruct the surgeon's view (Horiguchi et al 1998).…”

“…In these cases, one of the options to facilitate the visualisation of the anterior capsule is the use of vital dyes to stain the anterior capsule of the lens before proceeding with capsulorhexis (Pandey et al 2000, Dada et al 2004). The importance of having a better visualisation of the flap during capsulorhexis is that it increases surgery success, decreases the chance of anterior capsule tears during phacoemulsification, and ensures the safe inthe-bag implantation of the intraocular lens (Pandey et al 2000, Marback et al 2001.…”

Methylene blue-related corneal edema and iris discoloration

“…Trypan blue (0.025%) is ge nerally considered safer than other dyes because it does not cause postoperative inflammation, endothelial dysfunction, residual staining of the anterior chamber, or iris staining (2) . The use of inappropriate dyes or dyes at inappropriate concentrations may result in severe ocular toxicity (3,4) .…”