Trypan blue capsule staining to visualizethe capsulorhexis in cataract surgery

Melles, Gerrit R.J.; Waard, Peter W.T. de; Pameyer, Jan H.; Beekhuis, W. H.

doi:10.1016/s0886-3350(99)80004-2

Cited by 291 publications

(188 citation statements)

References 7 publications

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“…In our case, as in other cases of white cataract, we stained anterior capsule with 0.05% gentian violet under the viscoelastic material. Based on our experience, we agree with other authors 6,7 that this method is easier and safer than the original method under an air bubble 8 .…”

Section: Discussionsupporting

confidence: 90%

Phacoemulsification in eyes with white cataract

Chakrabarti

Singh

Krishnadas

2000

Journal of Cataract & Refractive Surgery

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SUMMARY -Phacoemulsification of white cataracts is associated with some difficulties and a higher rate of intraoperative complications. The aim of this report is to describe one of these cases and the possible ways to manage them. We report on cataract surgery in a 79-year-old patient with white mature cataract and insufficient mydriasis because of the pseudoexfoliation syndrome. The use of vital dyes for staining the anterior capsule enhances visualization and helps perform continuous curvilinear capsulorrhexis, which is a key point for performing successful phacoemulsification. In case of small pupils because of insufficient pharmacological mydriasis, we can either enlarge the pupil or work through it. Meticulous preoperative biomicroscopic and A-scan examination (the type of cataract according to intralental A-scan findings) can help select appropriate phaco technique. Despite a higher rate of intraoperative complications, white cataracts can be safely operated on with phacoemulsification technique.

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Section: Discussionsupporting

confidence: 90%

Phacoemulsification in eyes with white cataract

Chakrabarti

Singh

Krishnadas

2000

Journal of Cataract & Refractive Surgery

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“…9 Dyes used include indocyanine green 0.5%, gentian violet 0.1%, methylene blue 0.1%, subcapsular fluorescein and trypan blue (Vision Blue). 3,4,10,11 Some dyes considered inappropriate for cataract surgery include gentian violet and methylene blue. These have been known to cause corneal oedema postoperatively and this has been attributed to endothelial toxicity of these dyes.…”

Section: Discussionmentioning

confidence: 99%

“…3 However, trypan blue stains the lens capsule better and has been subject to more rigorous assessment of its safety in intraocular surgery. 4,12,13 As early as 1967, trypan blue has been used in ophthalmology to achieve vital staining of the cornea and conjunctiva. 14 It has also been used to examine endothelial cells after cataract surgery and in donor corneal grafts without any documented adverse effects.…”

Section: Discussionmentioning

confidence: 99%

“…Permanent discolouration of ocular tissue has not been observed. 4 Clinical observation during capsulorrhexis with trypan blue demonstrates greater staining of the posterior surface of the anterior lens capsule. This is easily seen with the operating microscope during capsulorrhexis when the capsule is often folded on itself.…”

Section: Eyementioning

confidence: 99%

“…3 Use of an agent containing the dye, trypan blue, has become popular with cataract surgeons. 4 This product is commercially available as Vision Blue s (D.O.R.C. International b.v.), which contains 0.6 mg trypan blue, 1.9 mg sodium monohydrogen orthophosphate, 0.3 mg sodium dihydrogen orthophosphate, 8.2 mg sodium chloride, sodium hydroxide for adjusting pH, and water for injection.…”

Section: Introductionmentioning

confidence: 99%

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A histological analysis of lens capsules stained with trypan blue for capsulorrhexis in phacoemulsification cataract surgery

Singh

Sarodia

Brown

et al. 2003

Eye

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Purpose Staining of anterior lens capsules with dye to facilitate completion of continuous curvilinear capsulorrhexis is now being used more frequently in phacoemulsification of white and mature cataracts with poor red reflexes. This study examined the histological characteristics of anterior lens capsules stained with trypan blue. The layer(s) of the lens capsule that stained with dye and the extent of accumulation of dye in these layers of the lens capsule were determined. To the best of our knowledge this has not been described before. Methods A series of 10 stained lens capsules were analysed histologically. The dye used in this study consisted of a standard sterile, noninflammatory, nonpyrogenic, 2 ml solution containing 0.6 mg/ml of trypan blue. Following capsulorrhexis, samples were sent to the laboratory for histological analysis. Frozen sections (8 lm) were prepared and examined with the light microscope. All 10 capsules were cut by frozen section to preserve trypan blue staining (which would be leached by processing) and then subjected to immunohistochemistry for collagen IV. Immunohistochemical analysis using markers for type IV collagen were done on formalinfixed specimens for morphological comparison with the frozen sections. A counterstain highlighted the epithelium. Results Continuous curvilinear capsulorrhexis was successfully and easily completed in all cases without any complications. Frozen section analysis using light microscopy demonstrated accumulation of trypan blue dye in the basement membrane of the lens capsule. Staining was concentrated in the portion of the membrane adjacent to the lens epithelium. The lens epithelium could not be clearly identified on the frozen sections. Consequently, immunohistochemical analysis with markers for type IV collagen was performed. A counterstain highlighted the epithelium. This confirmed that the layer staining with trypan blue was the basement membrane, a consistent feature on all the specimens. Conclusions Trypan blue selectively stains the basement membrane of the anterior lens capsule. There is a concentration of dye in the basement membrane adjacent to the lens epithelial cell layer. The lens cortex does not appear clinically to stain with trypan blue. This enables surgeons to distinguish the lens capsule from the cortex and provides sufficient contrast for successful completion of continuous curvilinear capsulorrhexis during cataract surgery.

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