Abstract
Purpose
We report a case of inadvertent staining of the vitreous with Trypan Blue during cataract surgery.
Case summary
We performed cataract surgery in a 44-year-old male patient on an eye with mature cataract. Preoperatively, he had no zonular weakness or lens subluxation. We used trypan blue to stain the anterior capsule to facilitate capsulorhexis. We observed zonular weakness during surgery. During phacoemulsification, the dye entered into the vitreous cavity through the area of zonular weakness and a sudden loss of the red fundus reflex developed. However, we did not perform any specific procedure to correct the problem and finished phacoemulsification and intraocular lens insertion. After surgery, slit lamp examination showed a blue fundal glow, which persisted for 1 week. As expected, the patient’s BCVA was better than before the operation.
Conclusions
Use of trypan blue is relatively safe for use in cataract surgery. But to use trypan blue or other dye during cataract surgery, it is necessary to have careful pre operative ocular examination. And if some risk factors like zonular weakness or lens subluxation exists, more caution during surgery is needed.
References
1. Horiguchi M, Miyake K, Ohta I, Ito Y. Staining of the lens capsule for circular continuous capsulorrhexis in eyes with white cataract. Arch Ophthalmol. 1998; 116:535–7.
2. Melles GR, de Waard PW, Pameyer JH, Houdijn Beekhuis W. Trypan blue capsule staining to visualize the capsulorhexis in cataract surgery. J Cataract Refract Surg. 1999; 25:7–9.
3. Jacob S, Agarwal A, Agarwal S. . Trypan blue as an adjunct for safe phacoemulsification in eyes with white cataract. J Cataract Refract Surg. 2002; 28:1819–25.
4. Dada VK, Sharma N, Sudan R. . Anterior capsule staining for capsulorhexis in cases of white cataract; comparative clinical study. J Cataract Refract Surg. 2004; 30:326–33.
5. Singh AJ, Sarodia UA, Brown L. . A histological analysis of lens capsules stained with trypan blue for capsulorrhexis in phacoemulsification cataract surgery. Eye. 2003; 17:567–70.
6. Wong VW, Lai TY, Lee GK. . A prospective study on trypan blue capsule staining under air vs under viscoelastic. Eye. 2006; 20:820–5.
8. Haritoglou C, Eibl K, Schaumberger M. . Functional outcome after trypan blue-assisted vitrectomy for macular pucker:a prospective, randomized, comparative trial. Am J Ophthalmol. 2004; 138:1–5.
9. Kodjikian L, Richter T, Halberstadt M. . Toxic effects of indocyanine green, infracyanine green, and trypan blue on the human retinal pigmented epithelium. Graefes Arch Clin Exp Ophthalmol. 2005; 243:917–25.
10. Veckeneer M, van Overdam K, Monzer J. . Ocular toxicity study of trypan blue injected into the vitreous cavity of rabbit eyes. Grafes Arch Clin Exp Ophthalmol. 2001; 239:698–704.
11. Yetik H, Devranoglu K, Ozkan S. Determining the lowest trypan blue concentration that satisfactorily stains the anterior capsule. J Cataract Refract Surg. 2002; 28:988–91.
12. Chowdhury PK, Raj SM, Vasavada AR. Inadvertent staining of the vitreous with trypan blue. J Cataract Refract Surg. 2004; 30:274–5.
14. Kayikiçioğ lu O, Erakgün T, Güler C.Trypan Blue mixed with sodium hyaluronate for capsulorhexis. J Cataract Refract Surg. 2001; 27:970.
15. Lanzi IM, Mertz MM. Why mix trypan blue with viscoelastic agents? J Cataract Refract Surg. 2003; 29:435–6.