Non-infectious endophthalmitis associated with trypan blue use in cataract surgery

Background The visualization of the anterior lens capsule is greatly enhanced by trypan blue staining facilitating the creation of a continuous curvilinear capsulorhexis. Trypan blue has been deemed safe in this setting. Methods We report the findings and management of a retrospective interventional case series comprising three eyes that developed non-infectious endophthalmitis following routine trypan blue staining of the anterior lens capsule with the same batch of Vission (0.6 mg/ml) during uncomplicated small incision phacoemulsification of 17 consecutive eyes. Results On post-op day 1, 18% had an increased cellular response in the anterior chamber and anterior vitreous precluding fundus visualization, 12% had a hypopyon. Initial visual acuity (VA) ranged from hand motions to light perception. Eyes were initially managed with topical and oral steroids. Two eyes underwent vitrectomy. Vitreous cultures were all negative. One eye had a repeat vitrectomy to remove an epiretinal membrane. Final VA achieved was 20/80, 20/20 and 20/20. Conclusion Trypan blue may be associated with severe intraocular inflammation. Presented in part at the 2005 Annual Meeting of the Association of Research in Vision and Ophthalmology (Ft. Lauderdale, FL, May 2006), at the 2005 XXIII Annual Meeting of the American Society of Retinal Specialists (Montreal, Canada, August 2005), at the 2005 Annual Meeting of the American Academy of Ophthalmology (Chicago, Il, Oct 2005) and at the II Congress of the Sociedad Panamericana de Retina y Vítreo (Cartagena de Indias, Colombia, May 2006). Supported in part by a Tyson ARVO Travel Award by the Pan American Ophthalmological Foundation.