Methylene blue-related corneal edema and iris discoloration

Abstract

We report the case of a 70-year-old female patient who developed corneal edema and iris discoloration following the inadvertent use of 1% methylene blue instead of 0.025% trypan blue to stain the anterior capsule during cataract phacoemulsification surgery. Copious irrigation was performed upon realization of incorrect dye use. Corneal edema and iris discoloration developed during the early postoperative period and persisted at 24-months follow-up. However, keratoplasty was not required. The intracameral use of 1% methylene blue has a cytotoxic effect on the corneal endothelium and iris epithelium. Copious irrigation for at least 30 min using an anterior chamber maintainer may improve outcomes.

A Review of Corneal Endotheliitis and Endotheliopathy: Differential Diagnosis, Evaluation, and Treatment

“…Perfluorodecalin and perfluoro- n -octane, fluorocarbons used in retinal detachment repair, have been associated with corneal dysfunction when accidentally retained after surgery [47–49]. Inadvertent intraoperative use of 1% methylene blue in place of 0.025% trypan blue in cataract surgery has been reported as causing permanent endothelial damage [50]. Other drugs, such as phenylephrine, have been shown to cause endotheliitis only in the case of epithelial compromise [51].…”