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Balyan M, Jain AK, Malhotra C, Ram J, Dhingra D. Achieving successful capsulorhexis in intumescent white mature cataracts to prevent Argentinian flag sign - A new multifaceted approach to meet the challenge. Indian J Ophthalmol 2021; 69:1398-1403. [PMID: 34011708 PMCID: PMC8302304 DOI: 10.4103/ijo.ijo_1903_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose: To present a case series of intumescent white cataract cases managed by a new surgical technique to attain a single stage Continuous Curvilinear Capsulorhexis (CCC). Methods: The series included 60 eyes of 60 patients with white cataract which underwent preoperative anterior chamber depth, lens thickness and ultrasonographic A-scan for intralenticular spikes. A partial size main port (~1.8mm) is created as the first entry into the anterior chamber (AC). A 30-gauge needle of insulin syringe entered through a limbal stab incision is used to decompress the anterior and posterior intralenticular compartments. Following which a standard size, one stage capsulorhexis was performed in a trypan blue stained capsule using microcapsulorhexis forceps entered through the partial sized trapezoidal main port. The main port was secondarily enlarged for phacoemulsification. Results: Based on the intraoperative findings, 43 eyes were categorized as Intumescent type-1 cataracts i.e., with presence of actual liquefied cortex aspirated using 30-gauge needle and 17 eyes as Intumescent type-2 cataracts, i.e., presence of swollen lens without any obvious liquefied cortex. Standard size, circular and centred CCC was achieved in 100% of the cases and no Argentinean flag sign was noted. Surgeon perceived raised intralenticular pressure in 41% of the cases in type-1 subset and 61% cases in type-2 subset (P-0.06). Posterior capsular plaque was observed in 22% of the cases, adherent cortex in 25% and anterior capsular plaque in 5% of the cases. At 6weeks follow up 92% patients had best corrected visual acuity of 20/40 or better. Conclusion: A multi-layered approach can help in attaining successful CCC in cases of white mature cataract with high intralenticular pressure.
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Affiliation(s)
- Monika Balyan
- Cataract and Refractive Services, Advanced Eye Centre PGIMER, Chandigarh, India
| | - Arun Kumar Jain
- Cataract and Refractive Services, Advanced Eye Centre PGIMER, Chandigarh, India
| | - Chintan Malhotra
- Cataract and Refractive Services, Advanced Eye Centre PGIMER, Chandigarh, India
| | - Jagat Ram
- Cataract and Refractive Services, Advanced Eye Centre PGIMER, Chandigarh, India
| | - Deepika Dhingra
- Cataract and Refractive Services, Advanced Eye Centre PGIMER, Chandigarh, India
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Real-time intraoperative dynamics of white cataract-intraoperative optical coherence tomography-guided classification and management. J Cataract Refract Surg 2021; 46:598-605. [PMID: 32271296 DOI: 10.1097/j.jcrs.0000000000000086] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate morphological characteristics and intraoperative dynamics of different types of white cataract using intraoperative optical coherence tomography (iOCT). SETTING Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. DESIGN Prospective interventional study. METHODS Fifty eyes with white cataract undergoing phacoemulsification were evaluated. The primary outcome measure was the classification of white cataract based on morphology and intraoperative dynamics on iOCT. The secondary outcome measure was rhexis-related complications. RESULTS Four types of white cataract were identified based on iOCT-type I (9 eyes), type II (3 eyes), type III (24 eyes), and type IV (14 eyes). Type I had regularly arranged lamellar cortical fibers, type II had continuous hyperreflective bands of cortical fibers with intralenticular clefts, type III had intralenticular clefts combined with areas of homogenous ground-glass appearance, and type IV had homogenous ground-glass appearance of the anterior lens cortex. Capsulorhexis in type I cataract was uneventful. In type II cataract, cortical bulge was observed in the anterior chamber on creating the initial nick, indicating raised intralenticular pressure (ILP) with an imminent risk of rhexis extension. A bimanual irrigation/aspiration was performed until lowering of ILP was observed on iOCT. In types III and IV, fluid release was observed on initiation of rhexis leading to partial (type III) or complete (type IV) lowering of ILP, with a mild-moderate risk of capsulorhexis extension. A continuous curvilinear capsulorhexis was achieved in all cases, with no case of posterior capsular tear or vitreous loss. CONCLUSIONS Intraoperative OCT helped elucidate intraoperative dynamics of the spectrum of white cataracts and facilitates completion of capsulorhexis.
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Capsule milking: Modification of capsulorhexis technique for intumescent cataract. J Cataract Refract Surg 2019; 43:585-589. [PMID: 28602316 DOI: 10.1016/j.jcrs.2017.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/24/2016] [Accepted: 01/19/2017] [Indexed: 11/20/2022]
Abstract
We describe a single-stage modification of the continuous curvilinear capsulorhexis that facilitates creation of a well-sized round and centered capsulorhexis in an intumescent cataract. This is done without special instrumentation. The modification is based on overcoming the problem of high intralenticular pressure. It involves physically flattening the central anterior capsule, specifically over the site of puncture, simultaneous puncture and aspiration for decompression, followed by flattening of the midperiphery of the lens where the capsulorhexis can be safely initiated. This minimizes the tendency of capsulorhexis runaway and allows 1-stage creation of a well-sized capsule opening for phacoemulsification.
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Andrade M, Moreno T, Muccillo M, Pigatto J, Camilo E. Evaluation of equine corneal endothelium after exposure to 0.05% brilliant blue - an in vitro study. ARQ BRAS MED VET ZOO 2019. [DOI: 10.1590/1678-4162-9969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT The aim of this study was to evaluate the immediate effects of 0.05% brilliant blue on corneal endothelium of horses. Thirty-eight corneas of 19 horses, male or female, of different ages were studied. Corneas were randomly divided into two groups. Group 1: Corneal endothelium was covered with 0.3mL of brilliant blue 0.05% for 60 seconds followed by rinsing with a balanced salt solution. Group 2: Corneal endothelium was covered with BSS for 60 seconds. The corneas were excised with an 8mm trephine and prepared to analyze posterior endothelial surface using a light microscope (24 corneas) and a scanning electron microscope (14 corneas). The equine posterior corneal endothelium surface observed by optical microscopy and scanning electron microscopy revealed a continuous layer of polygonal cells of uniform size and shape in both the control and treatment groups. Due to non-normal residuals at ANOVA mean comparison, a generalized linear model was utilized at 5% level of significance. The chi-square test stated that treatment and control group were not different statistically. The 0.05% brilliant blue did not cause damage to equine corneal endothelium.
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Affiliation(s)
| | - T.M. Moreno
- Universidade Federal do Rio Grande do Sul, Brazil
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Sharma B, Abell RG, Arora T, Antony T, Vajpayee RB. Techniques of anterior capsulotomy in cataract surgery. Indian J Ophthalmol 2019; 67:450-460. [PMID: 30900573 PMCID: PMC6446625 DOI: 10.4103/ijo.ijo_1728_18] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Optimal outcomes of a cataract surgery largely depend on the successful performance of an anterior capsulotomy. It is one of the most important steps of modern cataract surgery which reduces the risk of capsular tears and ensures postoperative stable intraocular lens (IOL). Anterior capsulotomy is considered ideal if it is round, continuous, well-centered, and overlaps the implanted IOL around its circumference. If any of these features is missing, it can be a cause of impedance for desired surgical and visual outcomes. Manual can opener and manual capsulorhexis are the routine standard techniques employed for manual extracapsular cataract extraction and phacoemulsification, respectively. Recent increasing use of femtosecond laser cataract surgery has allowed cataract surgeons to obviate inherent inaccuracies of manual anterior capsulotomy techniques. There is an ongoing quest to find an ideal, risk free, and surgeon-friendly technique of anterior capsulotomy that can be employed for surgery in all types of cataracts.
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Affiliation(s)
- Bhavana Sharma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Robin G Abell
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Tarun Arora
- Eye Care Centre, Princess Margaret Hospital, Nassau, New Providence, Bahamas
| | - Tom Antony
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Rasik B Vajpayee
- Royal Victorian Eye and Ear Hospital; Vision Eye Institute; Department of Ophthalmology, University of Melbourne, Melbourne, Australia
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Bracha P, Ciulla TA, Baumal CR. Vital Dyes in Vitreomacular Surgery. Ophthalmic Surg Lasers Imaging Retina 2019; 49:788-798. [PMID: 30395665 DOI: 10.3928/23258160-20181002-07] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 09/09/2018] [Indexed: 11/20/2022]
Abstract
Vital dyes contain complex molecules with chromophores that stain living tissues and have greatly enhanced identification and removal of transparent vitreoretinal tissues during surgery. Several "chromovitrectomy" dyes are frequently used by vitreoretinal specialists, including indocyanine green, trypan blue, brilliant blue G, and triamcinolone acetonide; other dyes are also under investigation. Trypan Blue was approved by the U.S. Food and Drug Administration (FDA) for epiretinal membrane removal, and preservative-free triamcinolone acetonide was approved by the FDA for intraocular use. However, currently available chromovitrectomy dyes have their limitations, and of particular concern for some of them is the possibility for acute and chronic toxicity to the neurosensory retina and retinal pigmented epithelium. The potentially irreversible acute toxicity and other limitations, such as lack of long-term safety profiles, highlight the need for further advancements. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:788-798.].
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El-Abedin Rajab GZ, Demer JL. Long-term results of surgical excision of conjunctival retention cyst using trypan blue with methylcellulose. Am J Ophthalmol Case Rep 2019; 14:28-31. [PMID: 30815620 PMCID: PMC6377388 DOI: 10.1016/j.ajoc.2019.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 07/01/2018] [Accepted: 01/22/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose Conjunctival retention cysts may recur if not completely removed. However, the cyst wall often ruptures during surgical excision, making complete removal difficult. In order to ensure complete cyst excision, we used a method of staining the inner cyst wall using trypan blue augmented by Methyl cellulose. Observation Interventional study. Staining was performed by injecting trypan blue using an insulin needle. Then the needle was kept in place and methyl cellulose was injected to make the cyst content viscous to avoid its collapse after removing the needle. By using this technique, it was possible to excise the lesion as a whole. Three patients were included (unilateral). Two patients had cysts that were secondary to trachoma and were followed for up to 2 years without recurrence. A third patient had a conjunctival cyst following strabismus surgery was not successfully removed. Conclusion This method is simple and effective for complete excision of conjunctival retention cysts exception for cysts post strabismus surgery.
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Affiliation(s)
| | - Joseph L Demer
- Department of Ophthalmology, Stein Eye Institute, UCLA, Los Angeles, CA, USA.,Department of Neurology, UCLA, Los Angeles, CA, USA.,Neuroscience Interdepartmental Program, UCLA, Los Angeles, CA, USA.,Bioengineering Interdepartmental Program, UCLA, Los Angeles, CA, USA
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Sharma N, Singhal D, Maharana PK, Dhiman R, Shekhar H, Titiyal JS, Agarwal T. Phacoemulsification with coexisting corneal opacities. J Cataract Refract Surg 2019; 45:94-100. [DOI: 10.1016/j.jcrs.2018.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/24/2018] [Accepted: 09/19/2018] [Indexed: 10/27/2022]
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Park YM, Park JY, Lee JS, Lee JE, Byon IS, Park SW. Comparative analysis of brilliant blue G and an intracameral illuminator in assisting visualization of the anterior capsule in eyes with vitreous hemorrhage. J Cataract Refract Surg 2018; 42:1015-21. [PMID: 27492100 DOI: 10.1016/j.jcrs.2016.03.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 03/28/2016] [Accepted: 03/30/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare the safety and efficacy of 0.025 mg/mL brilliant blue G (BBG) and an intracameral illuminator for visualizing the anterior capsule. SETTING University-based tertiary referral center, South Korea. DESIGN Retrospective cases series. METHODS The medical records of patients with vitreous hemorrhage for which they had pars plana vitrectomy and cataract surgery were retrospectively reviewed. The patients were classified into 2 groups. The BBG group comprised patients having capsule staining with BBG. The illuminator group comprised patients who had capsulorhexis assisted with an intracameral illuminator. The status of the endothelial cells was analyzed. RESULTS There were 27 eyes in the BBG group and 35 eyes in the illuminator group. In the BBG group, endothelial cell density (ECD) was reduced 3 months after surgery (10.6% loss) (P = .003). The illuminator group had no significant loss (1.5% loss) (P = .264). The ECD loss was greater in the BBG group than the illuminator group 3 months after surgery (P = .01). There was no statistically significant difference in the coefficient of variation of cell area or percentage of hexagonal cells between the 2 groups. CONCLUSIONS The ECD loss was higher in eyes with 0.025 mg/mL BBG staining than in eyes using an intracameral illuminator. Further studies are necessary to establish the safety profile of BBG on the endothelium. FINANCIAL DISCLOSURE None of the authors has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Young Min Park
- From the Departments of Ophthalmology, Gyeongsang National University School of Medicine (Y.M. Park), Gyeongsang National University Changwon Hospital, Changwon-si, Gyeongsangnam-do, School of Medicine (J.Y. Park, J.S. Lee, J.E. Lee, S.W. Park), Pusan National University and Medical Research Institute, Pusan National University Hospital, Pusan, and Pusan National University Yangsan Hospital (Byon), Yangsan, South Korea
| | - Jung Y Park
- From the Departments of Ophthalmology, Gyeongsang National University School of Medicine (Y.M. Park), Gyeongsang National University Changwon Hospital, Changwon-si, Gyeongsangnam-do, School of Medicine (J.Y. Park, J.S. Lee, J.E. Lee, S.W. Park), Pusan National University and Medical Research Institute, Pusan National University Hospital, Pusan, and Pusan National University Yangsan Hospital (Byon), Yangsan, South Korea
| | - Jong Soo Lee
- From the Departments of Ophthalmology, Gyeongsang National University School of Medicine (Y.M. Park), Gyeongsang National University Changwon Hospital, Changwon-si, Gyeongsangnam-do, School of Medicine (J.Y. Park, J.S. Lee, J.E. Lee, S.W. Park), Pusan National University and Medical Research Institute, Pusan National University Hospital, Pusan, and Pusan National University Yangsan Hospital (Byon), Yangsan, South Korea
| | - Ji Eun Lee
- From the Departments of Ophthalmology, Gyeongsang National University School of Medicine (Y.M. Park), Gyeongsang National University Changwon Hospital, Changwon-si, Gyeongsangnam-do, School of Medicine (J.Y. Park, J.S. Lee, J.E. Lee, S.W. Park), Pusan National University and Medical Research Institute, Pusan National University Hospital, Pusan, and Pusan National University Yangsan Hospital (Byon), Yangsan, South Korea
| | - Ik Soo Byon
- From the Departments of Ophthalmology, Gyeongsang National University School of Medicine (Y.M. Park), Gyeongsang National University Changwon Hospital, Changwon-si, Gyeongsangnam-do, School of Medicine (J.Y. Park, J.S. Lee, J.E. Lee, S.W. Park), Pusan National University and Medical Research Institute, Pusan National University Hospital, Pusan, and Pusan National University Yangsan Hospital (Byon), Yangsan, South Korea
| | - Sung Who Park
- From the Departments of Ophthalmology, Gyeongsang National University School of Medicine (Y.M. Park), Gyeongsang National University Changwon Hospital, Changwon-si, Gyeongsangnam-do, School of Medicine (J.Y. Park, J.S. Lee, J.E. Lee, S.W. Park), Pusan National University and Medical Research Institute, Pusan National University Hospital, Pusan, and Pusan National University Yangsan Hospital (Byon), Yangsan, South Korea.
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Pandey SK, Sharma V. Cataract surgery training during ophthalmology residency in India: Challenges and how to overcome them? Indian J Ophthalmol 2018; 65:1279-1280. [PMID: 29208806 PMCID: PMC5742954 DOI: 10.4103/ijo.ijo_1032_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Suresh K Pandey
- SuVi Eye Institute and Lasik Laser Center, Kota, Rajasthan, India
| | - Vidushi Sharma
- SuVi Eye Institute and Lasik Laser Center, Kota, Rajasthan, India
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Ozkiriş A, Arslan O, Cicik E, Köylüoglu N, Evereklioglu C. Open-Sky Capsulorrhexis in Triple Procedure: With or without Trypan Blue? Eur J Ophthalmol 2018; 13:764-9. [PMID: 14700096 DOI: 10.1177/1120672103013009-1005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To establish the beneficial effects of trypan blue 0.1% capsule staining in open-sky capsulorrhexis during triple procedure. METHODS Patients who underwent penetrating keratoplasty (PK) with phacoemulsification and intraocular lens (IOL) implantation were divided into two groups. Group 1 consisted of 31 eyes of 26 patients with a mean age 64.4 +/- 6.9 years and anterior lens capsule was stained with trypan blue 0.1% to perform open-sky capsulorrhexis. In Group 2, capsulorhexis was performed without staining of the anterior capsule in 19 eyes of 17 patients with a mean age 60.6 +/- 5.3 years. The rates of complete capsulorrhexis and intra- and postoperative capsule-related complications were compared between the groups. RESULTS The most common diagnosis before PK was corneal opacification in both groups. Open-sky capsulorrhexis was not completed in 3 eyes (9.6%) in Group 1 and in 9 eyes (47.3%) in Group 2. The rates of incomplete capsulorrhexis, posterior capsule tear, and transscleral fixation IOL implantation were higher in Group 2 (for each, p < 0.05). The diameters of capsulorrhexis were smaller than 4.5 mm in one eye in Group 1 and in two eyes in Group 2, and larger than 6.5 mm in two eyes in Group 1 and in three eyes in Group 2. Malposition of IOL, zonular dialysis, retinal detachment, and pupil capture were only observed in eyes in Group 2. In the follow-up period, there were no adverse reactions due to application of trypan blue in Group 1. CONCLUSIONS Trypan blue staining of the anterior capsule during triple procedure helps the surgeon perform open-sky capsulorrhexis more easily and safely and in proper dimensions, provides positive effects on the other steps of the surgery, and decreases the rate of posterior capsule tear formation.
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Affiliation(s)
- A Ozkiriş
- Erciyes University Medical Faculty, Kayseri, Turkey.
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Om Parkash R, Mahajan S, Om Parkash T. Modified 30 G needle trypan blue staining technique under air for a uniform and consistent anterior capsule staining. Clin Ophthalmol 2017; 11:1651-1656. [PMID: 29075093 PMCID: PMC5608478 DOI: 10.2147/opth.s147510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To describe a trypan blue dye staining technique under air, a modification of the previously described 30 G needle under-air technique. DESIGN This is a prospective, randomized study of 1,000 eyes of 952 patients undergoing phacoemulsification in a private practice setting from January 2015 to August 2016. Three variants as a modification of the previously known 30 G needle technique are described. In our technique, after injecting one drop of the dye under air, the needle is kept in the anterior chamber (AC) for 15 seconds. In the second variation, along with the additional hold time, 0.05 mL air is injected prior to dye injection to deepen the AC in eyes with shallow ACs or in cases with increased posterior pressure. The third variation is the selective painting approach in which more than one drop is injected for a homogenous staining. MAIN OUTCOME MEASURES The main outcome measures were safety and reproducibility of the technique along with homogeneity and uniformity of the anterior capsule staining. RESULTS AC remained stable during the hold time of 15 seconds with no egress of air. No iatrogenic trauma occurred in any of the cases. All cases had a homogeneously stained anterior capsule. The staining intensity was excellent in 80.8% of the eyes and good in 19.2% of the eyes. CONCLUSION This is a safe, simple, and cost-effective technique which achieves consistent, uniform, and reproducible staining. It overcomes the shortcomings of the known 30 G needle technique.
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Terzariol M, Hünning PS, Brambatti G, Albuquerque LD, Neumann C, Pigatto JA. Effects of intracameral brilliant blue on the corneal endothelium of swine: in vitro study. PESQUISA VETERINÁRIA BRASILEIRA 2016. [DOI: 10.1590/s0100-736x2016000800016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract: The aim was to investigate the ultrastructural changes in the corneal endothelium of pigs induced by intracameral 0.05% brilliant blue. Twenty swine corneas were separated into two groups, the right eye bulbs (control group) and the left eye bulbs (experimental group) of the same animal. All the eye bulbs were evaluated with specular microscopy. The cornea of the right eye bulbs was excised and in the left eye bulbs 0.2ml of 0.05% brilliant blue vital dye (OPTH-blue±) was injected into the anterior chamber, where it remained for one minute. Then the anterior chamber was cleaned with a balanced salt solution injection and the cornea was excised too. All the corneas were evaluated by scanning electron microscopy to evaluate the changes on the endothelium caused by the brilliant blue dye. There were no significant differences between the right corneal endothelium cells and the left corneal endothelium cells with scanning electron microscopy after intracameral use of 0.05% brilliant blue dye. The 0.05% brilliant blue dye concentration did not cause deleterious effects for the swine corneal endothelium after intracameral use and can be a choice for safe staining of the anterior capsule of the lens in cataract surgery.
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Genç S, Güler E, Çakır H, Özertürk Y. Intraoperative complications in intumescent cataract surgery using a phaco capsulotomy technique. J Cataract Refract Surg 2016; 42:1141-5. [DOI: 10.1016/j.jcrs.2016.06.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/01/2016] [Accepted: 06/04/2016] [Indexed: 10/21/2022]
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Giammaria D, Giannotti M, Scopelliti A, Pellegrini G, Giannotti B. Under-air staining of the anterior capsule using Trypan blue with a 30 G needle. Clin Ophthalmol 2013; 7:233-5. [PMID: 23386783 PMCID: PMC3563348 DOI: 10.2147/opth.s40351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The original technique of staining the anterior capsule of the lens with Trypan blue involves the injection of an air bubble in the anterior chamber. A drawback of this technique is the possible instability of the anterior chamber caused by the sudden exit of air when the dye is injected with the cannula through the side-port incision. Other staining techniques that use viscoelastic substances to increase the stability of the anterior chamber and to dose the injected dye have been described. The authors present an under-air staining technique of the anterior capsule using one drop of Trypan blue injected with a 30 G needle through the peripheral cornea. This procedure prevents the air bubble from escaping the anterior chamber and allows fast and selective staining of the capsule.
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Investigation of the retinal biocompatibility of acid violet for chromovitrectomy. Graefes Arch Clin Exp Ophthalmol 2013; 251:1115-21. [DOI: 10.1007/s00417-013-2258-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 12/27/2012] [Accepted: 01/02/2013] [Indexed: 11/26/2022] Open
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Tsaousis KT, Kopsachilis N, Tsinopoulos IT, Dimitrakos SA, Kruse FE, Welge-Luessen U. Time-dependent morphological alterations and viability of cultured human trabecular cells after exposure to Trypan blue. Clin Exp Ophthalmol 2012; 41:484-90. [DOI: 10.1111/ceo.12018] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 10/01/2012] [Indexed: 12/01/2022]
Affiliation(s)
| | - Nikolaos Kopsachilis
- Department of Ophthalmology; Friedrich-Alexander University Erlangen-Nuremberg; Erlangen; Germany
| | - Ioannis T Tsinopoulos
- 2nd Department of Ophthalmology; Medical School; Aristotle University of Thessaloniki; Thessaloniki; Greece
| | - Stavros A Dimitrakos
- 2nd Department of Ophthalmology; Medical School; Aristotle University of Thessaloniki; Thessaloniki; Greece
| | - Friedrich E Kruse
- Department of Ophthalmology; Friedrich-Alexander University Erlangen-Nuremberg; Erlangen; Germany
| | - Ulrich Welge-Luessen
- Department of Ophthalmology; Friedrich-Alexander University Erlangen-Nuremberg; Erlangen; Germany
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Figueiredo CG, Figueiredo J, Figueiredo GB. Brazilian technique for prevention of the Argentinean flag sign in white cataract. J Cataract Refract Surg 2012; 38:1531-6. [DOI: 10.1016/j.jcrs.2012.07.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 04/03/2012] [Accepted: 04/15/2012] [Indexed: 11/25/2022]
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Jaber R, Werner L, Fuller S, Kavoussi SC, McIntyre S, Burrow M, Mamalis N. Comparison of capsulorhexis resistance to tearing with and without trypan blue dye using a mechanized tensile strength model. J Cataract Refract Surg 2012; 38:507-12. [PMID: 22340608 DOI: 10.1016/j.jcrs.2011.08.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 08/26/2011] [Accepted: 08/29/2011] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate the influence of trypan blue staining on capsulorhexis tear resistance using a model for mechanical measurement of the entire capsular bag of fresh human cadaver eyes. SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. DESIGN Experimental study. METHODS After the cornea and iris were removed, a 5.0 to 5.5 mm anterior continuous curvilinear capsulorhexis (CCC) was created; the capsule in study eyes was stained with trypan blue. The nucleus was hydroexpressed and the capsular bag was evacuated by irrigation/aspiration. Two metal shoetree-shaped fixtures were implanted separately in the capsular bag and assembled using a screw nut. After zonulectomy, the fixture-capsular bag assembly was removed from the eye and loaded onto a mechanized tester. The fixtures were separated at a velocity of 7.0 mm/min in 0.15 μm intervals to stretch the capsulorhexis to its rupture point. A graph was generated for each eye. RESULTS Ten study eyes were compared with 23 control eyes. The groups were comparable in donor age, time from death, and CCC diameter. The mean rupture load was 0.40 Newton (N) ± 0.13 (SD) in the trypan blue group and 0.39 ± 0.16 N in the control group (P=.94). The mean extension was 5.70 ± 0.99 mm and 5.85 ± 1.17 mm, respectively (P=.74). CONCLUSIONS There was no difference in CCC strength between trypan blue-stained capsules and control capsules. Staining with trypan blue did not reduce CCC tear resistance. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Ryan Jaber
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA
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Pelit A. Unintentional staining of the posterior lens capsule with trypan blue dye during phacoemulsification: case report. Int Ophthalmol 2012; 32:187-9. [PMID: 22350078 DOI: 10.1007/s10792-012-9534-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2010] [Accepted: 01/30/2012] [Indexed: 11/25/2022]
Abstract
We report a complication related to the use of trypan blue during capsular staining of the anterior lens capsule during phacoemulsification surgery. In phacoemulsification surgery of the left eye, trypan blue was injected using an air bubble technique. Unintentionally, trypan blue was administered under high pressure, dispersing the dye through the zonules leading to staining of the posterior capsule. This caused a temporary disturbance of visual acuity during the postoperative period.
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Affiliation(s)
- Aysel Pelit
- Department of Ophthalmology, Faculty of Medicine, Adana Teaching and Medical Research Center, Baskent University, Dadaloğlu Mh. 39.Sok. No: 6, Yüreğir-Adana, 01250, Turkey.
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Abstract
Use of vital dyes in ophthalmic surgery has gained increased importance in the past few years. Trypan blue (TB) has been a popular choice among anterior segment surgeons mainly due to its safety, ease of availability, and remarkable ability to enable an easy surgery in difficult situations mostly related to visibility of the targeted tissue. It is being used in cataract surgery since nearly a decade and its utilization has been extended to other anterior segment surgeries like trabeculectomy and corneal transplantation. This review will discuss the techniques and outcome of TB dye-assisted anterior segment surgeries.
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Kim B, Kang NY. Successful Removal of Apocrinehydrocytoma Using Indocyanine Green and Sodium Hyaluronate. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.8.994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Boyun Kim
- Department of Ophthalmology, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Nam Yeo Kang
- Department of Ophthalmology, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
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Rodrigues EB, Farah ME, Penha FM, Maia M, Meyer CH. Reply. Am J Ophthalmol 2010. [DOI: 10.1016/j.ajo.2010.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
PURPOSE The purpose of this study was to evaluate retinal nerve fiber layer (RNFL) thickness changes in eyes undergoing trypan blue-assisted macular surgery using optical coherence tomography-3. This is a prospective noncomparative, interventional, and observational case series of 35 eyes of 35 consecutive patients (15 eyes with macular hole, 14 eyes with idiopathic macular pucker, and 6 eyes with tractional diabetic macular edema) who underwent pars plana vitrectomy and peeling of the epiretinal membrane and/or internal limiting membrane assisted with 0.1 mL of 0.15% trypan blue. METHODS The quantitative analysis of the peripapillary RNFL by optical coherence tomography was performed before surgery and 6 months postoperatively in both eyes of the same patient. The main outcome measures were significant changes in RNFL thickness (overall and by quadrant). RESULTS Optical coherence tomography assessment of the macular status at 6 months postoperatively showed closure of all macular holes and improvement in foveal contour in all cases of macular pucker or most cases of diabetic macular edema. Dissociated RNFL at the area of internal limiting membrane removal was observed in 9 eyes. No statistical significant changes in the mean RNFL thickness overall or by quadrant were observed after surgery. CONCLUSION Trypan blue-assisted peeling of macular epiretinal membranes and/or internal limiting membrane does not induce significant changes in RNFL thickness as measured by optical coherence tomography-3. Internal limiting membrane peeling may induce visible changes of the inner retinal surface possibly because of microdefects on macular nerve fiber layers.
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Rodrigues EB, Penha FM, de Paula Fiod Costa E, Maia M, Dib E, Moraes M, Meyer CH, Magalhaes O, Melo GB, Stefano V, Dias AB, Farah ME. Ability of new vital dyes to stain intraocular membranes and tissues in ocular surgery. Am J Ophthalmol 2010; 149:265-77. [PMID: 19896637 DOI: 10.1016/j.ajo.2009.08.020] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 08/18/2009] [Accepted: 08/18/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the ability of novel dyes to stain lens capsule (LC), internal limiting membrane (ILM), epiretinal membrane (ERM), and vitreous. DESIGN Experimental study in animal and human donor eyes. METHODS Thirteen dyes, methyl violet, crystal violet, eosin Y, sudan black B, methylene blue, toluidine blue, light green, indigo carmine, fast green, congo red, evans blue, brilliant blue, and bromophenol blue, were injected onto the LC and ILM of enucleated porcine eyes. The vitreous was stained with 2 mL of dyes for 1 minute. Six dyes (indigo carmine, evans blue, fast green, light green, bromophenol blue, and brilliant blue) were selected for experiments in human donor eyes and freshly removed ERM. RESULTS In the porcine eyes, ILM staining with methylene blue, toluidine blue, indigo carmine, evans blue, bromophenol blue, and fast green was moderate, and methyl violet, crystal violet, brilliant blue, or sudan black resulted in strong staining. Methyl violet, crystal violet, sudan black, toluidine blue, and methylene blue caused histologic damage in porcine retinas. Vitreous examination revealed moderate staining with congo red, crystal violet, fast green, eosin Y, methylene blue, toluidine blue, brilliant blue, bromophenol blue, and methyl violet and strong staining with light green and evans blue. ERMs showed strong staining with 0.5% evans blue and moderate staining with 0.5% light green, fast green, brilliant blue, and bromophenol blue. Evaluation of donor eyes disclosed moderate staining with evans blue, light green, and bromophenol blue and strong staining with 0.5% brilliant blue. Moderate or strong staining of the vitreous occurred with most dyes. LC evaluation showed moderate staining with 0.5% evans blue, fast green, and brilliant blue, whereas 0.5% light green produced strong LC staining. CONCLUSIONS Brilliant blue shows the best ILM staining, whereas bromophenol blue, evans blue, and light green also stain ILM. Most dyes bind well to LC, vitreous, and ERM.
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The Use of Vital Dyes in Ocular Surgery. Surv Ophthalmol 2009; 54:576-617. [DOI: 10.1016/j.survophthal.2009.04.011] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 04/02/2009] [Accepted: 04/07/2009] [Indexed: 02/06/2023]
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Narayanan R, Kenney MC, Kamjoo S, Trinh THT, Seigel GM, Resende GP, Kuppermann BD. Toxicity of Indocyanine Green (ICG) in Combination with Light on Retinal Pigment Epithelial Cells and Neurosensory Retinal Cells. Curr Eye Res 2009; 30:471-8. [PMID: 16020280 DOI: 10.1080/02713680590959312] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the toxicity of indocyanine green (ICG) in combination with light. METHODS Human retinal pigment epithelial cells (ARPE-19) and rat neurosensory retinal cells (R28) were treated with four different concentrations of ICG in combination with light exposure. Cell viability, mitochondrial function, and DNA synthesis were measured. RESULTS All concentrations of ICG with 10 min of light exposure caused a significant decrease in mitochondrial dehydrogenase activity in R28 and ARPE-19 cells. ICG without light exposure did not decrease mitochondrial dehydrogenase activity. In both cell lines, [(3)H]thymidine incorporation was increased when treated with ICG with or without light. R28 cells did not show any significant decrease in cell viability. CONCLUSIONS The duration of light was a significant factor in ICG toxicity. ICG needs to be used with caution as it decreases the mitochondrial dehydrogenase activity and increases the DNA synthesis in retinal cells, markers for cell toxicity and dysfunction.
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Affiliation(s)
- Raja Narayanan
- Department of Ophthalmology, University of California-Irvine, 118 Med Surge I, Irvine, CA 92697-4375, USA
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Pereira FA, Werner L, Milverton JE, Coroneo MT. Miyake-Apple posterior video analysis/photographic technique. J Cataract Refract Surg 2009; 35:577-87. [DOI: 10.1016/j.jcrs.2008.11.059] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 11/17/2008] [Accepted: 11/17/2008] [Indexed: 11/25/2022]
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Effect of trypan blue staining on the elastic modulus of anterior lens capsules of diabetic and nondiabetic patients. J Cataract Refract Surg 2009; 35:318-23. [DOI: 10.1016/j.jcrs.2008.10.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Revised: 10/26/2008] [Accepted: 10/30/2008] [Indexed: 11/19/2022]
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Automated vitrector-assisted iridectomy and phacoemulsification in eyes with coexisting cataract and adherent leucomas. Eye (Lond) 2008; 23:1345-8. [PMID: 19011608 DOI: 10.1038/eye.2008.283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To describe a surgical technique as an alternative to allograft corneal transplantation for management of cases with cataract and corneal opacity. METHODS Seven eyes of seven patients with adherent leucomas and cataract underwent phacoemulsification with intraocular lens (IOL) implantation. An automated vitrector was used to release the adherent leucoma and create an optical iridectomy at the start of surgery. Phacoemulsification with IOL implantation was performed in all eyes. The release of the iris adherence along with creation of an optical iridectomy improved visualization during phacoemulsification. RESULTS Phacoemulsification and IOL implantation could be performed successfully in all seven eyes. The median best-corrected visual acuity (BCVA) improved from 1/60 (range: (light perception) 6/36) preoperatively to 6/18 (range: 6/36-6/12) at last follow-up (average: 41 days). CONCLUSIONS This surgical technique is a viable option in cases with partial corneal opacification with coexisting cataract.
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Chang YS, Hsiao JH, Tseng SH, Kuo PH, Chen FK. Indocyanine green-assisted phacoemulsification in cases of complicated or simple advanced cataracts. J Formos Med Assoc 2008; 107:710-9. [PMID: 18796361 DOI: 10.1016/s0929-6646(08)60116-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND/PURPOSE During phacoemulsification for advanced cataracts, particularly when complicated by anterior segment abnormalities, capsulorhexis is very difficult and carries a high risk of complications. This study investigated the efficacy and safety of indocyanine green (ICG)-assisted phacoemulsification in complicated or simple advanced cataracts. METHODS Thirty-two patients (35 eyes) underwent phacoemulsification for complicated advanced cataracts (group 1) or simple advanced (mature/hypermature) cataracts (group 2). Anterior segment abnormalities (corneal opacity, small pupil, or glaucoma) in group 1 complicated phacoemulsification. In both groups, 0.5% ICG was used for capsulorhexis, and subsequent procedures were performed in the same routine manner. RESULTS Group 1 included 15 patients (17 eyes) with a mean age of 60.0 years. Group 2 included 17 patients (18 eyes) with a mean age of 69.4 years (p<0.05). Continuous curvilinear capsulorhexis was completed in all eyes in group 2, but radial tears occurred in four (23.5%) eyes in group 1 (p<0.05). Phacoemulsification was performed uneventfully in all eyes in both groups. Postoperative complications (corneal edema, vitreous prolapse, posterior capsule opacity, elevated intraocular pressure) were seen in five (27.8%) eyes in group 1 and four (23.5%) eyes in group 2 (p>0.05). None of these were attributed to the use of ICG. Visual acuity improved in all eyes in group 2, but in only 11 (64.7%) in group 1 (p<0.01). CONCLUSION ICG-assisted phacoemulsification is safe and helpful for complicated or simple advanced cataracts. Differences between the two groups in patient age, intraoperative complications, and visual outcome could be explained by differences in the cause(s) of advanced cataracts.
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Affiliation(s)
- Yi-Sheng Chang
- Department of Ophthalmology and Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Subtle signs of anterior vitreous face disturbance during posterior capsulorhexis in pediatric cataract surgery. J Cataract Refract Surg 2008; 34:163-7. [PMID: 18165099 DOI: 10.1016/j.jcrs.2007.08.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Accepted: 08/20/2007] [Indexed: 11/24/2022]
Abstract
In 4 patients with congenital cataract, subtle signs of anterior vitreous face (AVF) disturbance were documented during posterior continuous curvilinear capsulorhexis. The signs were vitreous strands in the anterior chamber, vitreous strands attached to the capsule flap, and distortion of the anterior and posterior capsulorhexis margins; the latter is considered a pathognomonic sign of AVF disturbance. As a result of the early recognition, modifications to the cataract surgery technique were made.
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Chéour M, Ben Brahim F, Zarrad A, Khémiri N, Mghaieth K, Kraiem A. [Trypan blue capsule staining for phacoemulsification in white cataract]. J Fr Ophtalmol 2007; 30:914-7. [PMID: 18046275 DOI: 10.1016/s0181-5512(07)74028-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study the results of phacoemulsification in eyes with white cataract using trypan blue for capsule staining. PATIENTS AND METHODS Thirty patients who had white cataract were included in this prospective study. They had phacoemulsification and continuous curvilinear capsulorhexis using trypan blue. Intraoperative problems related to capsulorhexis and phacoemulsification as well as postoperative outcomes where analyzed. Postoperative examinations were done at 1 day, 1 week, and 1, 3, 6, and 12 months. The mean follow-up was 10 months. RESULTS Complet capsulorhexis was achieved in 26 cases. Intraoperative complications included incomplet capsulorhexis in four cases (13.3%) and conversion to a conventional extraction technique in two cases. There were no cases of posterior capsular tear. Twenty-eight eyes (93.3%) had a final best corrected visual acuity at 8/10 or better. Postoperative complications included moderate transient corneal edema in six cases (20%) and iritis in three cases (10%). There were no complications related to the use of trypan blue. CONCLUSION Phacoemulsification using trypan blue was safe and effective in managing white cataract and had a high success rate.
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Affiliation(s)
- M Chéour
- Service d'ophtalmologie, Hôpital Habib Thameur, Tunis, Tunisie.
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Allen RC, Oetting TA. Indocyanine green toxicity. Ophthalmology 2007; 114:197; author reply 197. [PMID: 17198861 DOI: 10.1016/j.ophtha.2006.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2006] [Accepted: 08/02/2006] [Indexed: 10/23/2022] Open
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Akin T, Aykan U, Karadayi K, Aydin A, Yildiz TF, Bilge AH. Capsulorhexis in White Cataract Using a Green-Light Endoillumination Probe. Ophthalmic Surg Lasers Imaging Retina 2007; 38:520-2. [DOI: 10.3928/15428877-20071101-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Stevens S, Werner L, Mamalis N. Corneal Edema and Permanent Blue Discoloration of a Silicone Intraocular Lens by Methylene Blue. Ophthalmic Surg Lasers Imaging Retina 2007; 38:136-41. [PMID: 17396694 DOI: 10.3928/15428877-20070301-08] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To report a silicone intraocular lens (IOL) stained blue by inadvertent intraoperative use of methylene blue instead of trypan blue and the results of experimental staining of various lens materials with different concentrations of the same dye. MATERIALS AND METHODS A "blue dye" was used to enhance visualization during capsulorhexis in a patient undergoing phacoemulsification with implantation of a three-piece silicone lens. Postoperatively, the patient presented with corneal edema and a discolored IOL. Various IOL materials were experimentally stained using methylene blue. Sixteen lenses (4 silicone, 4 hydrophobic acrylic, 4 hydrophilic acrylic, and 4 polymethylmethacrylate) were immersed in 0.5 mL of methylene blue at concentrations of 1%, 0.1%, 0.01%, and 0.001%. These lenses were grossly and microscopically evaluated for discoloration 6 and 24 hours after immersion. RESULTS The corneal edema resolved within 1 month after the initial surgical procedure. After explantation, gross and microscopic analyses of the explanted silicone lens revealed that its surface and internal substance had been permanently stained blue. In the experimental study, all of the lenses except the polymethylmethacrylate lenses were permanently stained by methylene blue. The hydrophilic acrylic lenses showed the most intense blue staining in all dye concentrations. CONCLUSIONS This is the first clinicopathological report of IOL discoloration due to intraocular use of methylene blue. This and other tissue dyes may be commonly found among surgical supplies in the operating room and due diligence is necessary to avoid mistaking these dyes for those commonly used during ocular surgery.
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Affiliation(s)
- Scott Stevens
- John A. Moran Eye Center, University of Utah, Salt Lake Ciy, Utah 84132, USA
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Nanavaty MA, Johar K, Sivasankaran MA, Vasavada AR, Praveen MR, Zetterström C. Effect of trypan blue staining on the density and viability of lens epithelial cells in white cataract. J Cataract Refract Surg 2006; 32:1483-8. [PMID: 16931259 DOI: 10.1016/j.jcrs.2006.04.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2005] [Accepted: 04/03/2006] [Indexed: 11/18/2022]
Abstract
PURPOSE To assess the effect of anterior capsule staining with trypan blue 0.0125% on the density and viability of the lens epithelial cells (LECs). SETTING Iladevi Cataract and IOL Research Center, Ahmedabad, India. METHODS This randomized prospective study comprised 40 eyes having phacoemulsification for white mature cataract. Patients were randomized to have the anterior capsule stained with 0.1 mL trypan blue 0.0125% solution before the anterior capsulorhexis (Group 1, n = 20) or to have no anterior capsule staining before the anterior capsulorhexis (Group 2, n = 20). The density and viability of LECs were analyzed. The first 20 samples (10 from Group 1, 10 from Group 2) were stained with hematoxylin-eosin for cell density analysis using image-analysis software. The remaining 20 samples (10 from each group) were stained with a solution containing 0.5 microM calcein AM and 5 microM propidium iodide for 10 minutes at 37 degrees C for viability assay. RESULTS The mean cell density in Group 1 (with staining) was 3533.15 cells/mm(2) +/- 664.01 (SD). This was significantly lower than the mean of 4235.59 +/- 414.93 cells/mm(2) in Group 2 (no staining) (P = .01). The mean capsule area covered with LECs (80.75% +/- 8.04% versus 94.63% +/- 3.78%) and the mean live LECs in the covered area (51.69% +/- 11.54% versus 68.67% +/- 9.15%) were also significantly lower in Group 1 (P = .002). CONCLUSION Staining the anterior capsule with trypan blue affected the density and viability of LECs.
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Affiliation(s)
- Mayank A Nanavaty
- Iladevi Cataract & IOL Research Centre, Raghudeep Eye Clinic, Ahmedabad, India
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Guo S, Tutela AC, Wagner R, Caputo AR. A comparison of the effectiveness of four biostains in enhancing visualization of the vitreous. J Pediatr Ophthalmol Strabismus 2006; 43:281-4. [PMID: 17022161 DOI: 10.3928/01913913-20060901-02] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the effectiveness of four biostains in vitreous staining as a means to facilitate clean anterior vitrectomy. MATERIALS AND METHODS Four biostains (fluorescein, indocyanine green, trypan blue, and triamcinolone acetonide) were used to stain the transparent vitreous of human cadaver and monkey cadaver eyes. Results were compared and recorded by digital photography and videography. RESULTS Of the four biostains, triamcinolone acetonide best highlighted the vitreous. Although fluorescein, indocyanine green, and trypan blue also produced acceptable vitreous staining, the surrounding ocular structures were slightly stained as well. CONCLUSION All four biostains enhanced visualization of the vitreous. However, triamcinolone acetonide best highlighted the vitreous.
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Affiliation(s)
- Suqin Guo
- Institute of Ophthalmology and Visual Science, New Jersey Medical School, Newark, New Jersey, USA
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Fan DSP, Yip WWK, Yu CBO, Rao SK, Lam DSC. Updates on the Surgical Management of Paediatric Cataract with Primary Intraocular Lens Implantation. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2006. [DOI: 10.47102/annals-acadmedsg.v35n8p564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
With the advent of modern surgical techniques, paediatric cataract has become much more manageable. Intraocular lens (IOL) implantation is the standard of care for patients over the age of 2 years. The use of IOL in young infants is still controversial. In addition, there are still unresolved issues, such as the minimum age at which IOL can be safely implanted, IOL power selection and IOL power calculation. The current trends in the management of the above challenges are discussed. Although numerous reports on the prevention and management of posterior capsule opacification have been published, there are ongoing intensive debates and research. Long-term postoperative complications like glaucoma and rhegmatogenous retinal detachment are problems that cannot be overemphasised and these issues are also reviewed.
Key words: Congenital cataract, Intraocular lens, Posterior capsule opacification
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Affiliation(s)
| | - Wilson WK Yip
- The Chinese University of Hong Kong, Kowloon, Hong Kong
| | | | | | - Dennis SC Lam
- The Chinese University of Hong Kong, Kowloon, Hong Kong
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Jacobs DS, Cox TA, Wagoner MD, Ariyasu RG, Karp CL. Capsule Staining as an Adjunct to Cataract Surgery. Ophthalmology 2006; 113:707-13. [PMID: 16581432 DOI: 10.1016/j.ophtha.2006.01.024] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Revised: 12/12/2005] [Accepted: 01/19/2006] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This document evaluates currently available data in the published literature to answer the question of whether the use of dye such as indocyanine green or trypan blue to stain the lens capsule to improve visualization is safe and effective as an adjunct to cataract surgery. METHODS Literature searches conducted in March 2003 and May 2004 retrieved 139 citations. The panel members reviewed the abstracts and selected 47 of possible clinical relevance for review. An additional 14 articles were identified for evaluation. Of the 61 articles reviewed, the panel members selected 36 for the panel methodologist to review and rate according to the strength of the evidence. A level I rating was assigned to properly conducted, well-designed, randomized clinical trials; a level II rating was assigned to well-designed cohort and case-control studies; and a level III rating was assigned to case series and case reports. RESULTS There is level III evidence that indocyanine green, trypan blue, and fluorescein are each effective in staining the lens capsule and that indocyanine green and trypan blue provide better ease of use and visualization of the capsule than fluoroscein. There is level II evidence that staining the capsule is helpful in completing capsulorrhexis and that it is helpful for pediatric patients under age 5 years and in cases of white cataract. The overall surgical advantage of a completed continuous curvilinear capsulorrhexis using dye has not been demonstrated, but this may be related to the outcome measures chosen rather than a failure to confer advantage. There are substantial data indicating that trypan blue 0.1% is not toxic to the cornea. There are limited data suggesting that indocyanine green 0.125% to 0.5% is not toxic to anterior segment structures. CONCLUSIONS There are data confirming that dye is safe and effective as an adjunct for capsule visualization in cataract surgery. It is reasonable to use dye when inadequate capsule visualization may compromise the outcome in cataract surgery. More studies are needed to confirm a lack of toxicity of indocyanine green and trypan blue, particularly in the event of posterior segment or longer duration exposure.
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Titiyal JS, Sinha R, Sharma N, Vajpayee RB. Dye-assisted small incision cataract surgery in eyes with cataract and coexisting corneal opacity. Eye (Lond) 2006; 20:386-8. [PMID: 15746947 DOI: 10.1038/sj.eye.6701854] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Allen RC, Russell SR, Schluter ML, Oetting TA. Retained posterior segment indocyanine green dye after phacoemulsification. J Cataract Refract Surg 2006; 32:357-60. [PMID: 16565018 DOI: 10.1016/j.jcrs.2005.12.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2005] [Accepted: 05/22/2005] [Indexed: 10/24/2022]
Abstract
We describe a patient who had indocyanine green (ICG) staining of the anterior capsule for phacoemulsification of a traumatic cataract. Intraoperatively, the ICG extended into the posterior segment. Postoperatively, the patient developed ICG toxicity to the retina and had a vitrectomy to remove the ICG. We believe ICG extended into the vitreous through an area of zonular dehiscence.
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Affiliation(s)
- Richard C Allen
- Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242-1091, USA
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Abstract
PURPOSE OF REVIEW This paper reviews the recent literature regarding anterior capsular staining. RECENT FINDINGS Safety and efficacy of dyes used in facilitating visualization of the anterior capsule during phacoemulsification are compared. Advantages of using different techniques for injection of the dyes are discussed. SUMMARY Trypan Blue and Indocyanine Green appear to be most effective in staining the anterior capsule with the highest safety profile. Injection strategies should be aimed at reducing uncontrolled dispersion especially into the vitreous.
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Affiliation(s)
- Faruk Ozturk
- Department of Ophthalmology, University of Cincinnati, Ohio, USA
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Luo YHL, Poole TRG, Griffiths MF. Safe and effective visualisation of vitreous in the anterior chamber with intracameral fluorescein to facilitate its complete removal. Eye (Lond) 2005; 20:951-5. [PMID: 16123782 DOI: 10.1038/sj.eye.6702062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Wong VWY, Lai TYY, Lee GKY, Lam PTH, Lam DSC. A prospective study on trypan blue capsule staining under air vs under viscoelastic. Eye (Lond) 2005; 20:820-5. [PMID: 16096664 DOI: 10.1038/sj.eye.6702032] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AIM To compare the safety and effectiveness of trypan blue capsule staining under air vs under viscoelastic. METHODS A total of 52 consecutive patients planned for phacoemulsification of white mature cataract were randomly assigned to trypan blue staining under air or under viscoelastic. Perioperative changes in best-corrected visual acuity (BCVA), central corneal thickness (CCT), and endothelial cell density (ECD) were compared between the two groups. The differences in operating and phacoemulsification times, staining pattern, and complications between the two groups were also recorded. RESULTS Phacoemulsification of white mature cataract was performed in 50 (96%) eyes. The median preoperative BCVA was hand movement. No significant differences in the baseline characteristics were found between the two groups. At 3 months after phacoemulsification, the median BCVA improved to 0.8. The mean CCT returned to preoperative level by 1 month postoperatively and the mean ECD loss was 11.9% 3 months postoperatively. No significant differences in median BCVA, mean phacoemulsification and operation times, mean CCT, and mean ECD were found between the two groups. CONCLUSIONS Trypan blue staining of the anterior lens capsule under air or under viscoelastic were similarly effective and safe methods for the phacoemulsification of white mature cataract.
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Affiliation(s)
- V W Y Wong
- Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
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Abstract
PURPOSE To report a new modified method using the mixture of an ophthalmic viscosurgical devices (Healon V) and trypan blue solution to facilitate complete removal of a conjunctival cyst. METHOD A 54-year-old woman was referred to us for removal of a conjunctival cyst in her right eye. To achieve a complete removal of the conjunctival cyst, a mixture of Healon V and trypan blue solution was injected through a 27-gauge needle into the cyst. RESULTS This new technique achieved excellent visualization with an easy and complete resection of the cyst. CONCLUSIONS The mixture of Healon V and trypan blue is effective in delineating the capsule while preserving its integrity during removal. Such a technique may also have a role in facilitating visualization and excision of other cystic conjunctival lesions.
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Affiliation(s)
- Akira Kobayashi
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan.
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Baykara M, Avci R, Yücel A, Ozçetin H. Dynamics of indocyanine green dye in the anterior chamber. J Cataract Refract Surg 2005; 31:1256-8. [PMID: 16039511 DOI: 10.1016/j.jcrs.2005.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Khng C, Snyder ME. Indocyanine green-emitted fluorescence as an aid to anterior capsule visualization. J Cataract Refract Surg 2005; 31:1454-5. [PMID: 16105625 DOI: 10.1016/j.jcrs.2005.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Melendez RF, Kumar N, Maswadi SM, Zaslow K, Glickmank RD. Photodynamic actions of indocyanine green and trypan blue on human lens epithelial cells in vitro. Am J Ophthalmol 2005; 140:132-4. [PMID: 16038657 DOI: 10.1016/j.ajo.2004.12.086] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2004] [Accepted: 12/27/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the toxicity and photodynamic activity of indocyanine green (ICG) and trypan blue (TryB) on cultured human lensepithelial cells (LECs). DESIGN Experimental study. METHODS Lens epithelial cell viability was assessed after treatment with ICG and TryB concentrations ranging from 0.025 to 5.0 mg/ml, and exposure to 806 nm diode laser. RESULTS At ICG concentrations below 0.5 mg/ml, there was > or =75% cell viability; at higher ICG concentrations there was dose-dependent cytotoxicity in addition to loss of cellular viability due to ICG photosensitization. TryB had little cytotoxicity to the LECs: >80% cells were viable irrespective of the dye concentration or laser treatment. CONCLUSIONS These data indicate that ICG may have application as a photosensitizer in the selective eradication of residual LECs after cataract surgery to reduce the incidence of posterior capsule opacification.
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Affiliation(s)
- Robert F Melendez
- Department of Ophthalmology, University of Texas Health Science Center, San Antonio, 78229, USA.
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Chang YS, Tseng SY, Tseng SH, Chen YT, Hsiao JH. Comparison of dyes for cataract surgery. Part 1: cytotoxicity to corneal endothelial cells in a rabbit model. J Cataract Refract Surg 2005; 31:792-8. [PMID: 15899458 DOI: 10.1016/j.jcrs.2004.07.020] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate the corneal endothelial cytotoxicity of dyes for capsule staining in cataract surgery. SETTING Department of Ophthalmology and Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan. METHODS Cultured corneal endothelial cells of New Zealand white rabbits were exposed for 1 minute to 1 of the following dyes (various concentrations): indocyanine green (ICG), methylene blue (MB), gentian violet (GV), trypan blue (TB), and fluorescein sodium (FS). The degree of cell damage was determined by in vitro staining with TB and comparison with results in a control group. The effect of longer exposure (up to 10 minutes) to ICG 0.25% was also investigated. Structural changes in corneal endothelial cells after dye exposure were evaluated by light microscopy and transmission electron microscopy (TEM). RESULTS Indocyanine green 0.25%, MB 0.20%, GV 0.01%, TB 0.40%, and FS 10% did not induce significant damage to corneal endothelial cells. Significant cytotoxicity was observed with the following or higher dye concentrations: ICG 0.50%, MB 0.50%, and GV 0.10%. Exposure to ICG 0.25% for 1 to 10 minutes showed a trend toward cytotoxicity after 10 minutes. On TEM, corneal endothelial cells that had been exposed to ICG 0.50% showed remarkable organelle swelling and disruption, electron-dense granules, and cell lysis. CONCLUSION One minute of exposure to ICG 0.25%, MB 0.20%, GV 0.01%, TB 0.40%, and FS 10% appeared to be safe as determined by no cytotoxic effects on rabbit corneal endothelial cells in culture.
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Affiliation(s)
- Yi-Sheng Chang
- Department of Ophthalmology, and the Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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