Trypan blue dye for anterior segment surgeries

Visualization of preretinal membranes using trypan blue in patients with traction retinal detachments

OBJECTIVE

Surgical repair of complex tractional retinal detachments (TRDs) can be challenging due to the difficulty in delineating the fibroglial membranes from the underlying retinal surface. We describe the visual and retinal reattachment rate with the intraoperative use of trypan blue (TB) to visualize proliferative fibrous membranes in patients with TRDs.

DESIGN

Retrospective study.

PARTICIPANTS

Seventeen patients who underwent a pars plana vitrectomy for surgical TRD repair with TB use between January 1, 2005, and December 31, 2020.

METHODS

Patient charts were retrospectively evaluated for surgical details, preoperative and postoperative logMAR best-corrected visual acuity (BCVA) and status of retinal attachment om days 30 and 90 and at the most recent follow-up visit.

RESULTS

In the cohort of 17 patients, TRDs were found to be secondary to proliferative diabetic retinopathy, complications from endophthalmitis, open globe injury, and neovascularization secondary to a retinal vein occlusion. Mean ± SD preoperative BCVA was 1.7 ± 1.7 logMAR (Snellen, 20/1000), whereas postoperative BCVA at the most recent follow-up visit was 1.4 ± 1.2 logMAR (Snellen, 20/500). The use of TB was successful in delineating the proliferative preretinal membranes in 100% of patients, with no residual staining of posterior segment tissues or adverse reactions related to the dye noted at postoperative visits. Eighty-eight percent (15 of 17) and 76% of retinas (13 of 17) were attached at postoperative month 3 and 6 visits, respectively.

CONCLUSION

TB can be a useful adjunct tool to visualize and allow for a thorough removal of tractional fibrous proliferative epiretinal membranes in patients with complex TRDs, possibly yielding better surgical and long-term reattachment outcomes.

Corneal amyloid staining after trypan blue in Descemet's membrane endothelial keratoplasty

Purpose

This case report seeks to highlight impressive photographs of amyloid staining with trypan blue that persisted after DMEK surgery with 3 years follow-up. This has only been reported in the literature twice previously, and may have contributed to visual symptoms in the early post-operative period of this patient.

Observations

We report a case of an 82-year-old patient with concurrent Fuchs' corneal endothelial dystrophy and lattice corneal dystrophy who suffered permanent trypan blue staining of the amyloid deposits after descemet's membrane endothelial keratoplasty (DMEK) surgery.

Conclusions and importance

Trypan blue staining of amyloid deposits in the corneal stroma is permanent, with research suggesting potential stimulation of progression or recurrence of amlyoid deposition. This is relevant for all anterior segment surgeons using trypan blue in the setting of primary (eg. lattice corneal dystrophy) or secondary amyloid deposition (eg. polymorphous amyloid degeneration, chronic inflammation, systemic disease). Trypan blue staining should be limited or alternative surgical options such as descemet's stripping automated endothelial keratoplasty (DSAEK) considered.

Selective laser capsulotomy complications: Management and prevention

PURPOSE

To report how to manage and prevent the incomplete laser cut and following uncut tags of anterior capsular lens, performed using the selective laser capsulotomy.

METHODS

We describe three possible approaches: peeling the anterior capsulotomy disc with forceps, breaking the tags using the cystotomy needle tip, or cutting them using a 23-G vitrectomy scissors.

RESULTS

Using the 23-G vitrectomy scissors resulted in no complication. Peeling the anterior capsulotomy using the forceps instead caused zonular stress with subsequent risks of zonular dialysis, whereas using the cystotomy needle tip resulted in irregular capsulotomy rim and weakness all along the capsulotomy edge where micro tears caused a tear during the rest of cataract surgery.

CONCLUSION

Incomplete laser cut and subsequent discontinuous capsulotomy results in the presence of multiple tags which create strong adherence between the central capsulotomy disc and the peripheral capsule. Key steps of the procedure to prevent an incomplete laser cut, which are the anterior lens capsule staining and laser beam focusing, and how to correctly manage them, which may shorten the learning curve and enhance the outcomes.

Effect of Magnetic Microparticles on Cultivated Human Corneal Endothelial Cells

Purpose

To investigate effects of magnetic microparticles on movement of magnet controlled human corneal endothelial cells (HCECs).

Methods

Immortalized HCEC line (B4G12) and primary culture of HCECs were exposed to two commercially available magnetic micro- or nanoparticles, SiMAG (average size 100 nm) and fluidMAG (average size <1000 nm). Cell viability assays and reactive oxygen species production assays were performed. Cellular structural changes, intracellular distribution of microparticles, and expression levels of proteins related to cellular survival were analyzed. Ex vivo human corneas were exposed to microparticles to further evaluate their effects. Magnetic particle-laden HCECs were cultured under the influence of a neodymium magnet.

Results

No significant decrease of viability was found in HCECs after exposure to both magnetic particles at concentrations up to 20 µg/mL for 48 hours. However, high concentrations (40 µg/mL and 80 µg/mL) of SiMAG and FluidMAG significantly decreased viability in immortalized HCECs, and only 80 µg/mL of SiMAG and FluidMAG decreased viability in primary HCECs after 48 hours of exposure. There was relative stability of viability at various concentrations of magnetic particles, despite a dose-dependent increase of reactive oxygen species, lactate dehydrogenase, and markers of apoptosis. Ex vivo human cornea study further revealed that exposure to 20 µg/mL of SiMAG and fluidMAG for 72 hours was tolerable. Endocytosed magnetic particles were mainly localized in the cytoplasm. The application of a magnetic field during cell culture successfully demonstrated that magnetic particle-loaded HCECs moved toward the magnet area and that the population density of HCECs was significantly increased.

Conclusions

We verified short-term effects of SiMAG and fluidMAG on HCECs and their ability to control movement of HCECs by an external magnetic field.

Translational Relevance

A technology of applying magnetic particles to a human corneal endothelial cell culture and controlling the movement of cells to a desired area using a magnetic field could be used to increase cell density during cell culture or improve the localization of corneal endothelial cells injected into the anterior chamber to the back of the cornea.

Surgical goniolens for tag identification and removal in DMEK surgery

INTRODUCTION

We describe a novel technique for identifying endothelial Descemet membrane (DM) tags remaining after descemetorhexis in patients undergoing Descemet membrane endothelial keratoplasty (DMEK) surgery.

METHODS

A surgical goniolens is applied to the corneal surface after descemetorhexis in order to visualize the peripheral inner corneal layer at 360° and identify endothelial-DM tags.

RESULTS

A detailed visualization of the peripheral inner corneal layer is possible using goniolens, without using any staining in the anterior chamber.

CONCLUSION

The technique may be used to screen the posterior corneal surface for any retained endothelial-DM tags. It may to lower the risk of remaining tags and indirectly lower the incidence of DMEK graft detachment.

Corneal endothelial protection during manual small-incision cataract surgery: A narrative review

Cataract causes bilateral blindness in 20 million people globally, the vast majority of whom live in developing countries. Manual small-incision cataract surgery (MSICS) has emerged as an efficient and economical alternative to phacoemulsification, giving comparable results in terms of final visual gain. One of the important determinants of postoperative visual gain is the status of the corneal endothelium. Multiple factors such as corneal distortion, irrigation solution turbulence, mechanical trauma by instruments, nuclear fragments, intraocular lens contact, and free oxygen radicals, all have been implicated in causing corneal damage during cataract surgery. MSICS with posterior chamber intraocular lens implantation has been reported to cause an endothelial cell loss of 15.83%, which is comparable with other modes of cataract surgery like extracapsular cataract extraction and phacoemulsification. Thorough preoperative assessment of endothelial status and taking necessary steps for endothelial protection during surgery can decrease the endothelial cell loss and overall burden of pseudophakic bullous keratopathy. In addition to surgical techniques, the type of irrigating solutions, ocular viscoelastic devices, intracameral dyes, and drugs all affect the endothelial cell status. This review presents a summary of available literature on the protection of endothelial cells during different steps of MSICS. This is especially relevant for developing countries where large-scale MSICS cataract surgeries are performed to decrease the cataract blindness burden.

XEN Gel Staining with Trypan Blue: A Simple and Effective Technique to Improve Device Visualization during Implantation

The Xen Gel Stent (Allergan, Irvine, CA, USA) is a hydrophilic collagen-based gelatin tube of 6 mm in length which creates a channel of communication between the anterior chamber and the subconjunctival space allowing aqueous humor outflow. XEN is an ab interno, minimally invasive, glaucoma surgery device which has a better safety profile and offers a less invasive way of lowering intraocular pressure. Unfortunately, one of its weaknesses is that visualization of the implant during surgery is difficult, and this difficulty may be exacerbated, for instance, by a subconjunctival hemorrhage. The purpose of this paper is to describe a simple and effective technique for improving device visualization (XEN 45 μm) during the implantation. How to cite this article: Ramovecchi V, Franco F, Barbera GR. XEN Gel Staining with Trypan Blue: A Simple and Effective Technique to Improve Device Visualization during Implantation. J Curr Glaucoma Pract 2021;15(3):161-163.

Incidence of corneal transplantation after challenging cataract surgery in patients with and without corneal guttata

PURPOSE

To study the risk for corneal transplantation after phacoemulsification with dense cataract or posterior capsule rupture (PCR) and the impact of corneal guttata.

SETTING

Forty-nine Swedish cataract surgical units and 8 Swedish cornea transplantation units.

DESIGN

Registry-based cohort study.

METHODS

Patient data from the Swedish National Cataract Registry (2010 to 2012) were linked with data from the Swedish Cornea Transplant Registry (2010 to 2017). The outcome measures were risk for future corneal transplantation, visual acuity, and self-assessed visual function after phacoemulsification. Logistic and Poisson regression analyses with adjustment for confounder effects were used to investigate the association of the outcome measures with dense cataract, indicated by trypan blue capsular staining (TB) and PCR, separately and together.

RESULTS

Altogether, data from 276 362 cataract patients were linked with data from 2091 patients with endothelial failure who underwent corneal transplantation.The risk for future corneal transplantation increased more than 3-fold with the presence of dense cataract or PCR, and a trend toward an ever-higher risk with the combination of TB and PCR together, but without any significant synergy of corneal guttata. Dense cataract, but not PCR, was significantly associated with an increased probability of inferior visual acuity after phacoemulsification. The impact on satisfaction was not statistically significant for any of the factors.

CONCLUSIONS

Challenging cataract surgery increases the risk for future corneal transplantation equally in patients both with and without corneal guttata, despite a more vulnerable endothelium in the guttata group. This supports a strategy where PCR is limited and handled optimally and that cataract surgery is performed before the cataract turns critically dense.

Comparison of wash-out properties after use of the vital dye trypan blue in the form of an ophthalmic dye and bound in a sodium hyaluronate by Raman spectroscopy

PURPOSE

In cataract surgery, viscoelastics protect the corneal endothelium against phacoenergetic and mechanical damage and ensure anterior chamber stability. Vital dyes (trypan blue) are effective aids in anterior segment surgery, especially in challenging cases, but may lead to cytotoxic reactions depending on concentration and dose. A complete removal of the dye is therefore of great importance. Recently, a new viscoelastic colored with Trypan blue (Pe-Ha-Blue®PLUS) was introduced to increase the safety of ophthalmological procedures. The aim of the present work was to determine the residual amount of the dye Trypan Blue that remains on a slide during the routine application of two commercial products (Trypan Blue dye Vision Blue® and Pe-Ha-Blue®PLUS) by Raman spectroscopy.

MATERIALS AND METHODS

For both products, a test sample (after application of the substance, the slides were flushed according to the clinical procedure) and a reference sample (the substances remained on the slide) were imaged using a Raman spectroscope (LabRam 800 HR spectrometer (Horiba Jobin Yvon GmbH, Bensheim, Germany)) and then analyzed.

RESULTS

The remaining residues of the reference samples of both substances were clearly detected by the spectroscopy measurement. In the mean spectrum of the Vision Blue® test specimen, the Raman bands of Trypan blue were clearly visible at a Raman shift of 1200-1600 cm-1, indicating residues on the test specimen. The test sample of Pe-Ha-Blue®PLUS did not show any Raman bands in the typical Trypan blue Raman shift.

CONCLUSIONS

The results of our in-silico experiment showed that a drop of a combination of a vital dye with a viscoelastic could be washed-out more easily with BSS compared to a dye itself without viscoelastics. This suggests that at least in an in silico experiment the removal of both, the viscoelastics and the TB is easier compared to the removal of the TB alone. Further in-vitro experiment in pig cadaver eyes are planned to prove this washout effect. If this concept can be demonstrated, this could further increase the safety of dye-assisted ophthalmic procedures.

Alteration of fibrin hydrogel gelation and degradation kinetics through addition of azo dyes

Fibrin is a degradable biopolymer with an excellent clinical safety profile. Use of higher mechanical strength fibrin hydrogels is limited by the rapid rate of fibrin polymerization. We recently demonstrated the use of higher mechanical strength (fibrinogen concentrations >30 mg/ml) fibrin scaffolds for surgical implantation of cells. The rapid polymerization of fibrin at fibrinogen concentrations impaired our ability to scale production of these fibrin scaffolds. We serendipitously discovered that the azo dye Trypan blue (TB) slowed fibrin gelation kinetics allowing for more uniform mixing of fibrinogen and thrombin at high concentrations. A screen of closely related compounds identified similar activity for Evans blue (EB), an isomer of TB. Both TB and EB exhibited a concentration dependent increase in clot time, though EB had a larger effect. While gelation time was increased by TB or EB, overall polymerization time was unaffected. Scanning electron microscopy showed similar surface topography, but transmission electron microscopy showed a higher cross-linking density for gels formed with TB or EB versus controls. Based on these data we conclude that addition of TB or EB during thrombin mediated fibrin polymerization slows the initial gelation time permitting generation of larger more uniform fibrin hydrogels with high-mechanical strength.

Collector Channels: Role and Evaluation in Schlemm's Canal Surgery

OBJECTIVES

1) To elucidate the role of collector channels in the aqueous humor outflow pathway 2) To suggest anatomic and functional methods of imaging collector channels in-vitro and in-vivo and 3) To discuss the role of such imaging modalities in the surgical management of glaucoma.

METHODS

A thorough literature search was conducted on databases for studies published in English regarding the available methods to determine the role of collecting channels in normal and glaucomatous patients and to assess their patency.

RESULTS

Intraocular pressure (IOP) exists as a balance between aqueous humor production and aqueous humor outflow. Collector channels are an essential anatomical constituent of the distal portion of the conventional aqueous humor outflow pathway. There are different surgical options for glaucoma management and with the recent advances in Schlemm's canal-based surgeries, collector channel's patency became a key factor in determining the optimum management for the glaucomatous eye. The advent of anatomic imaging methods has improved the ability to visualize collector channel morphology in-vitro, including swept-source optical coherence tomography (SS-OCT), spectral domain optical coherence tomography (SD-OCT), micro-computed tomography (micro CT), new immunohistochemistry techniques and scanning electron microscopy. The recent advent of real-time assessment of collector channel patency (including evaluation of episcleral venous outflow, observation of episcleral venous fluid wave, and tracer studies utilizing fluorescein, indocyanine green, and trypan blue) has been validated by the aforementioned anatomic imaging modalities.

CONCLUSIONS

New modalities of in-vitro and in-vivo studies of collector channels provide promise to aid in the assessment of collector channel patency and individualization of surgical management for glaucoma patients.

Use of trypan blue as an aqueous tracer dye to investigate hypotony where cyclodialysis cleft is suspected

IMPORTANCE

A new method to help diagnose suspected cyclodialysis clefts.

BACKGROUND

To study the use of trypan blue stained aqueous flow patterns in diagnosing causes of hypotony where cyclodialysis clefts were suspected.

DESIGN

A case series in a tertiary care centre.

PARTICIPANTS

Ten subjects presenting with persistent hypotony and retinal changes.

METHODS

Trypan blue was injected into the anterior chamber.

MAIN OUTCOME MEASURES

The pattern of dye flow in the anterior chamber was categorized. Intraocular pressure prior to surgery was recorded.

RESULTS

All seven subjects with cyclodialysis clefts had a preferential flow to the cleft region. Two hypotonous subjects post trabeculectomy had rapid (5 seconds) and extensive lymphatic staining (6 o'clock hours extent) without visible bleb formation.

CONCLUSIONS AND RELEVANCE

Preferential flow of dye to the limbus is a reliable sign of cyclodialysis cleft and helps localize cleft extent. A new cause of hypotony, "lymphatic overdrain," is identified.

Determination of trypan blue efficacy in the mitigation of ex vivo canine PCO formation

PURPOSE

To determine whether trypan blue (TB) reduces canine lens epithelial cell (LEC) or corneal endothelial cell (CEC) viability in vitro; if cell death is noted, to subsequently evaluate the molecular mechanism.

METHODS

Cellular viability was determined using a lactate dehydrogenase (LDH) assay. In TB-treated LECs, caspase 3/7 activity was assessed to evaluate apoptosis; autophagy was evaluated using immunoblotting against LC3 and p62. To evaluate the effects of TB on ex vivo posterior capsule opacification (PCO), following mock cataract surgery, lens capsules were treated with TB and subsequently maintained in culture to determine LEC migration and proliferation.

RESULTS

Following acute exposure, TB did not significantly reduce LEC or CEC viability at any of the concentrations tested. Increased caspase 3/7 activity was found in LEC cultures treated with TB for an extended period of time; no change in LC3 or p62 expression was noted. Ex vivo PCO formation was not significantly altered by TB treatment.

CONCLUSIONS

Acute exposure to TB did not reduce LEC or CEC viability, and only longer exposure to TB was able to initiate apoptosis. Treatment with intraocular TB at the time of cataract surgery is likely safe to the CECs but will not prevent PCO formation.

Safety of Trypan Blue Capsule Staining to Corneal Endothelium in Patients with Diabetic Retinopathy

Purpose

To study the potential corneal endothelial cell toxicity of trypan blue (TB) when used for phacoemulsification to stain the anterior capsule in patients with diabetic retinopathy.

Methods

This was a single-center, prospective, randomized, individual cohort study. One eye in each patient with diabetic retinopathy underwent phacoemulsification without trypan blue capsule staining (control eye), while the other eye underwent phacoemulsification with trypan blue capsule staining (study eye). Both eyes underwent intraocular lens implantation. Preoperative and four-week postoperative quantitative and qualitative morphometric endothelial cell analyses of the cornea were performed using noncontact specular microscopy.

Results

There were no significant differences in endothelial cell density (mean ± SD for the study group: 2506.74 ± 413.99 cells/mm²; mean ± SD for the control eyes: 2466.34 ± 369.12 cells/mm²; P=0.316) or endothelial cell density (CD) loss% (mean CD loss% was 7.23 ± 13.31 for the study eyes and 9.94 ± 9.36 for the control eyes; P=0.157) four weeks after the operation. Additionally, no significant differences were seen in the percentage of hexagonal cells, coefficient of variation, or corneal thickness between the two groups preoperatively and 4 weeks postoperatively.

Conclusions

Direct administration of trypan blue into the anterior chamber for staining of the anterior capsule during cataract surgery did not result in any significant corneal endothelial changes on specular microscopy in patients with severe nonproliferative diabetic retinopathy or high-risk proliferative diabetic retinopathy at 4 weeks postoperatively. This trial is registered with NCT03755752.

Corneal staining during cataract surgery: Natural course, ASOCT features, and preventive measures

We report the natural course of the accidental injection of trypan blue into the corneal stroma while performing a routine cataract surgery by a resident during a training session. The corneal staining resolved with conservative medical treatment over 7 weeks. This case describes the anterior segment optical coherence tomography (ASOCT) features of corneal staining. It emphasizes on the relatively benign nature of this dye and the follow-up course. Causes that may be responsible for this untoward complication are highlighted with the necessary preventive measures that need to be taken care are also discussed.

Optimization of Direct Blue-14 dye degradation by Bacillus fermus (Kx898362) an alkaliphilic plant endophyte and assessment of degraded metabolite toxicity

Alkaliphilic bacteria possesses the ability to survive in the extreme conditions with high salt concentrations. The adaptability of alkaliphilic bacteria to extreme conditions has made them predominant degrader in the field of biodegradation. A moderately alkaliphilic endophyte was isolated from Centella asiatica with a potential to degrade a di-azo dye Direct Blue-14(DB-14). The isolate was identified as Bacillus fermus with 97% similarity strain Xmb064. On optimization, maximum of 92.76% biodegradation was attained with dye concentration at 68.78 ppm supplemented with 1 g of sucrose and 2.5% (v/v) of inoculum for 72 h incubation. Characterization of the biodegraded product carried out using UV-vis spectrophotometry, FT-IR and LC-MS confirmed the destabilization of di-azo bond followed with the degradation of DB-14. Cytogenotoxicity studies revealed the biodegraded products to be less toxic. The current study is the first report on the optimization, biotransformation and cytogenotoxicity of DB-14 by B. fermus strain Centella.

XEN Gel Stent Early Failure-dye-enhanced Ab-externo Revision

The XEN gel stent is an ab-interno minimally invasive glaucoma surgery device that reduces intraocular pressure by creating a subconjunctival drainage pathway. XEN intents to provide a safer and less invasive mean of lowering intraocular pressure. As with any new device, there is still some lack of experience and knowledge concerning efficacy, technique, and complications. We report a novel surgical approach for early bleb failure after XEN implantation.

How to cite this article

Ferreira NP, Pinto JM, Teixeira F, Pinto LA. XEN Gel Stent Early Failure-dye-enhanced Ab-externo Revision. J Curr Glaucoma Pract 2018;12(3):139-141.

Trypan blue as an affordable marker for automated live-dead cell analysis in image cytometry

The aim of the present study was to combine image cytometry and trypan blue (TB) exclusion staining for a reproducible high-throughput detection of dead cells, enabling TB as an inexpensive marker, to be affordable for many studies and creating the possibility to combine fluorochromes without or with less spectral overlap. Capillary blood was drawn from a healthy volunteer, red blood cells were lysed and leukocyte cell death was induced. Samples were stained with CD45-FITC, CD14-PE, TB and DAPI, and then analyzed using image cytometry (iCys). TB quenching control tests were performed using DAPI and CD45-FITC. Images were generated in .TIF and .JPEG format using iCys image cytometer. The images were analyzed using CellProfiler (CP) modules to optimize the analysis based on the aims of each phase of this study. CellProfiler Analyst (CPA) was used to classify cells throughout machine learning and to calculate sensibility of the classification. A sensitivity of 0.94 for dead cells and 0.99 for live cells was calculated using CPA. We did not see any quenching effects of the FITC staining. DAPI signal was reduced in the presence of TB. The results of the present study revealed that TB serves as a dead cell marker in an image cytometric analysis, being able to be combined with other fluorescence markers without loss of fluorescence intensity signal or overlapping emission spectrum. SCANNING 38:857-863, 2016. © 2016 Wiley Periodicals, Inc.

Effect of Trypan Blue on Descemet Membrane Elasticity

PURPOSE

To evaluate the effect of trypan blue on the elastic property of Descemet membrane (DM) by atomic force microscopy.

METHODS

Human corneas (n = 10) were obtained from the Illinois Eye Bank (Chicago, IL). The DM was isolated and divided into two halves, one half was stained with ophthalmic trypan blue (Vision Blue, 0.06%, DORC International), whereas the unstained other half served as control. The DM samples were then tested using the atomic force microscope. Data were analyzed using the Hertz model for the evaluation of the Young modulus of elasticity.

RESULTS

Atomic force microscopy showed higher cantilever deflection on trypan blue-stained DM compared with control, and the difference was statistically significant (P = 0.03). Force-distance curve analysis also revealed a statistically significant increase in the Young modulus of elasticity in the trypan blue-stained samples (10.5 ± 1.4 kPa) compared with the control (5.8 ± 0.8 kPa), (P < 0.0001).

CONCLUSIONS

Our results suggest that trypan blue may decrease DM elasticity and consequently increase its stiffness. This may influence the graft adherence when used for endothelial keratoplasty.

Reduction of conjunctival fibrosis after trabeculectomy using topical α-lipoic acid in rabbit eyes

PURPOSE

To evaluate the efficacy of α-lipoic acid (ALA) in reducing scarring after trabeculectomy.

MATERIALS AND METHODS

Eighteen adult New Zealand white rabbits underwent trabeculectomy. During trabeculectomy, thin sponges were placed between the sclera and Tenon's capsule for 3 minutes, saline solution, mitomycin-C (MMC) and ALA was applied to the control group (CG) (n=6 eyes), MMC group (MMCG) (n=6 eyes), and ALA group (ALAG) (n=6 eyes), respectively. After surgery, topical saline and ALA was applied for 28 days to the control and ALAGs, respectively. Filtrating bleb patency was evaluated by using 0.1% trepan blue. Hematoxylin and eosin and Masson trichrome staining for toxicity, total cellularity, and collagen organization; α-smooth muscle actin immunohistochemistry staining performed for myofibroblast phenotype identification.

RESULTS

Clinical evaluation showed that all 6 blebs (100%) of the CG had failed, whereas there were only 2 failures (33%) in the ALAG and no failures in the MMCG on day 28. Histologic evaluation showed significantly lower inflammatory cell infiltration in the ALAGs and CGs than the MMCG. Toxicity change was more significant in the MMCG than the control and ALAGs. Collagen was better organized in the ALAG than control and MMCGs. In immunohistochemistry evaluation, ALA significantly reduced the population of cells expressing α-smooth muscle action.

CONCLUSIONS

ΑLA prevents and/or reduces fibrosis by inhibition of inflammation pathways, revascularization, and accumulation of extracellular matrix. It can be used as an agent for delaying tissue regeneration and for providing a more functional-permanent fistula.

Optical correction of aphakia in children

There are several reasons for which the correction of aphakia differs between children and adults. First, a child's eye is still growing during the first few years of life and during early childhood, the refractive elements of the eye undergo radical changes. Second, the immature visual system in young children puts them at risk of developing amblyopia if visual input is defocused or unequal between the two eyes. Third, the incidence of many complications, in which certain risks are acceptable in adults, is unacceptable in children. The optical correction of aphakia in children has changed dramatically however, accurate optical rehabilitation and postoperative supervision in pediatric cases is more difficult than adults. Treatment and optical rehabilitation in pediatric aphakic patients remains a challenge for ophthalmologists. The aim of this review is to cover issues regarding optical correction of pediatric aphakia in children; kinds of optical correction , indications, timing of intraocular lens (IOL) implantation, types of IOLs, site of implantation, IOL power calculations and selection, complications of IOL implantation in pediatric patients and finally to determine the preferred choice of optical correction. However treatment of pediatric aphakia is one step on the long road to visual rehabilitation, not the end of the journey.

Endometrial dye instillation: a novel approach to histopathologic evaluation of morcellated hysterectomy specimens

The purpose of this prospective pilot case study was to determine whether instillation of trypan blue dye into the uterine cavity before laparoscopic hysterectomy and morcellation aids in gross identification of endometrium. The most common commercially available trypan blue stain, VisionBlue was used in this study. Instillation was performed at the beginning of the procedure using an embryo transfer catheter. A sterile solution of trypan blue, 0.5 mL, was instilled transcervically into the uterine cavities in 12 patients before laparoscopic hysterectomy with uterine morcellation. The morcellated specimens were sent for routine gross pathologic and histologic examination. It was concluded that intrauterine instillation of trypan blue stained the endometrium, thus aiding the pathologist in identification of the endometrium in morcellated uterine specimens.