Dye-enhanced cataract surgery. Part 3: posterior capsule staining to learn posterior continuous curvilinear capsulorhexis

PURPOSE: To evaluate the use of 2 dyes for staining the posterior capsule to enhance visualization during posterior continuous curvilinear capsulorhexis (PCCC). SETTING: Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Indocyanine green 0.5% (ICG) and trypan blue 0.1% were used to stain the posterior capsule for performing PCCC in 8 human eyes obtained postmortem. The eyes were prepared according to the posterior video technique of Miyake-Apple. After CCC and hydrodissection/delineation were performed, the nucleus was carefully delivered by hydroexpression. Cortical cleanup was completed by irrigation/aspiration. The posterior capsule was stained by instilling 1 microdrop of ICG (4 eyes) or trypan blue (4 eyes) in the capsular bag. A PCCC was then performed by 2 independent surgeons (4 eyes/surgeon) not familiar with this technique. Each surgeon also performed PCCC in 2 eyes without the use of dye. RESULTS: Both dyes facilitated the performance of PCCC after staining the otherwise transparent posterior capsule. It was easier to differentiate the stained posterior capsule flap from the underlying transparent anterior hyaloid phase of the vitreous. In addition, optic capture of an intraocular lens, with or without anterior vitrectomy, was easily accomplished because of the enhanced visualization by posterior capsule staining. CONCLUSIONS: Posterior capsule staining can be successfully used to learn and perform the PCCC procedure, combined with optic capture, anterior vitrectomy, or both.     

Dye-enhanced cataract surgery. Part 2: learning critical steps of phacoemulsification

PURPOSE: To use capsule dyes to enhance visualization to learn and perform various critical steps of the phacoemulsification procedure in a laboratory setting using postmortem human eyes. SETTING: Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Indocyanine green 0.5% (ICG) and trypan blue 0.1% were used to enhance visualization for performing critical steps of phacoemulsification in 8 human eyes obtained postmortem. All eyes were prepared according to the Miyake-Apple posterior video technique. After a continuous curvilinear capsulorhexis (CCC) was made, the dyes were used to enhance visualization for hydrodissection, hydrodelineation, and various maneuvers for nuclear emulsification and cortical cleanup. In 8 eyes, all the aforementioned steps were performed without using dye (control group). RESULTS: Both dyes helped enhance visualization during the critical steps of phacoemulsification. The use of a dye solution instead of balanced salt solution (BSS) for hydrodissection/delineation helped localize the complete plane of cleavage between the capsule and cortex and the nucleus-epinucleus complex. During various nuclear sculpting maneuvers, the use of dye helped visualization of the position of the phaco tip and its relation to the posterior capsule. It also helped localize remaining cortical fibers, facilitating complete cleaning of the capsular bag. CONCLUSIONS: Dye-enhanced cataract surgery was useful in learning various critical steps of phacoemulsification in a wet laboratory setting.     

Anterior capsule staining for capsulorhexis in cases of white cataract: comparative clinical study

PURPOSE: To compare the safety and efficacy of trypan blue 0.1%, gentian violet 0.001%, indocyanine green 0.5% (ICG), fluorescein 2%, and the patient's autologous blood for anterior capsule staining in cases of white cataract. SETTING: Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. METHODS: Fifty eyes of 50 patients with age-related white cataract had anterior capsule staining with trypan blue, ICG, or gentian violet under an air bubble or subcapsularly with fluorescein or autologous blood followed by phacoemulsification with foldable intraocular lens implantation. Each stain was used in 10 eyes. The ease of creating a continuous curvilinear capsulorhexis (CCC) and the complications during the surgery were noted. Postoperative examinations at 6 hours, 1 day, 1 week, and 1 month included slitlamp microscopy, uncorrected visual acuity, and best corrected visual acuity (BCVA). The staining patterns on the anterior capsule, side port, corneal tunnel, and anterior cortex were assessed intraoperatively and within 6 hours and at 1 day. The intraocular pressure (IOP) was assessed at 1 day; pachymetry, at 1 day and 1 month; and the endothelial cell count, at 1 month. RESULTS: The surgeon had best visualization during the anterior capsulorhexis with trypan blue, ICG, and gentian violet, and a complete CCC was achieved in all eyes in the 3 groups. Two eyes each in the fluorescein and autologous blood groups had extension of the CCC so that the capsulorhexis was complete but not curvilinear. Anterior capsule fibrosis was detected with trypan blue (1 eye) and ICG (2 eyes). The anterior vitreous was stained with fluorescein in 2 eyes. All eyes achieved a BCVA of 20/30 or better from 1 week postoperatively to the last follow-up. The side port and corneal tunnel were stained most intensely with gentian violet followed by trypan blue and ICG and less intensely with fluorescein and autologous blood. The IOP, pachymetry, and endothelial cell loss were comparable between the stains. CONCLUSION: Although trypan blue, ICG, gentian violet, fluorescein, and autologous blood were safely used to stain the anterior capsule for phacoemulsification in eyes with white cataract, trypan blue, ICG, and gentian violet were more effective in staining the capsule.     

白色白内障超声乳化术中吲哚青绿前囊膜染色的临床应用

目的 探讨吲哚青绿对晶状体前囊染色在白色白内障超声乳化术中的临床应用效果。方法 对白色白内障50例（50只眼）随机分成二组,各25只眼。其中染色组采用吲哚青绿辅助撕囊技术,观察术中及术后情况。结果 染色组25只眼全部成功,术中及术后无并发症。对照组25只眼有7只眼撕囊没有成功,改为开罐式截囊,其中2只眼在以后的操作中出现后囊破裂。结论 吲哚青绿辅助撕囊技术,对于没有眼底红光反射的白内障降低了撕囊难度,提高了连续环行撕囊的成功率,减少了白内障超声乳化术中及术后并发症的发生,使这类患者的超声乳化手术更加安全。     

吲哚菁绿运用于白色白内障超声乳化术中的临床研究

目的：探讨5g/L吲哚菁绿溶液前囊膜染色在白色白内障超声乳化术中连续环形撕囊的临床应用效果。

方法：白色白内障患者98例98眼,随机分为两组,观察组50例50眼,对照组48例48眼。对照组不做前囊膜染色。观察组采用黏弹剂下5g/L吲哚菁绿溶液前囊膜染色,前囊膜染色针抽取5g/L吲哚菁绿溶液0.1mL,自辅助切口注入到前囊膜中央表面,留置30s,平衡盐液置换出多余染料。两组均应用撕囊镊连续环形撕囊。

结果：观察组前囊膜呈现均匀的淡绿色,能见度显著提高,有48眼撕囊成功,成功率96%; 对照组有29眼撕囊成功,成功率60%,两组差异有统计学意义(P<0.05)。观察组术后裂隙灯显微镜下检查前房未见染料颗粒残存及虹膜炎及眼压升高等并发症。前房炎症反应、角膜透明度与对照组比较,差异无统计学意义。

结论：吲哚菁绿前囊膜染色使前囊清晰可辨,可提高对白色白内障患者术中撕囊的成功率,从而减少术中并发症的发生,使超声乳化白内障手术初学者较快掌握连续环形撕囊术,改善初学者的学习曲线。     

Staining the Anterior Capsule with Indocyanine Green or Trypan Blue for Capsulorhexis in Eyes with White Cataract

Aim: To assess the efficacy and safety of indocyanine green (ICG) 0.5% and trypan blue 0.1% for anterior capsule staining in cases of white cataract. Methods: This prospective study comprised 55 eyes of 55 patients with white cataract that had phacoemulsification with foldable intraocular lens implantation. ICG in 30 eyes and trypan blue in 25 eyes were used under air to stain the anterior lens capsule. The staining patterns and the ease of creating a continuous curvilinear capsulorhexis (CCC) were assessed; the intraoperative and postoperative complications were noted. The mean follow-up was 17.68±1.65 months. Result: Either ICG or trypan blue stained the anterior capsule uniformly. However, the staining provided by trypan blue was slightly superior. A CCC was successfully achieved in 25 eyes (100%) with trypan blue, and 29 eyes (96.7%) with ICG, respectively. There was no significant postoperative reaction in any eye. Conclusion: The use of vital dyes such as ICG and trypan blue guarantees a complete CCC and makes it possible to deliver the benefits of phacoemulsification in the patients with white cataract.     

前囊膜染色在白色白内障连续环形撕囊中的应用

目的 探讨白色白内障连续环形撕囊术中前囊膜染色的方法。方法 对128眼白色白内障施行超声乳化手术．用0．1％台盼蓝（trypanblue）前囊膜染色后．再做连续环形撕囊。58眼先在前房内注入空气泡，置换房水，在气泡下进行前囊膜染色：70眼在前房内先注入弥散性强的黏弹剂，应用特制的前囊膜染色针头（其末端封塞．出孔位于近末端弯曲面下方）．在黏弹剂下进行前囊膜染色。结果 12．8眼均获得满意的前囊膜着色。在气泡下染色前囊膜．同时伴有角巩膜隧道切口、辅助穿刺切口和虹膜隐窝着色。19眼染色过程中前房气泡逃逸，其中，4眼局部角膜内皮细胞着色。在黏弹剂下行前囊膜染色，术中前房稳定，无角膜内皮细胞着色．无角巩膜隧道切口、辅助穿刺切口和虹膜隐窝着色。结论 白色白内障的眼底红光反射缺失．连续环形撕囊操作困难。通过前囊膜染色增加了前囊膜与其下晶状体皮质的对比度．应用特制的前囊膜染色针头，在黏弹剂下行前囊膜染色，简单便捷，使前囊膜染色范围更具可控性．减少了染色剂对眼内其他组织的潜在损伤。     

生物活性染色剂在白色白内障撕囊术中的应用

目的 评价生物活性染色剂在白色白内障超声乳化手术中显现晶状体前囊的可行性和安全性等。方法 55例白色白内障随机编人台盼蓝和吲哚青绿前囊染色组。采用气泡下染色技术完成连续环形撕囊。结果 台盼蓝和吲哚青绿均可充分着染前囊。染色辅助撕囊的总成功率为98．2％。吲哚青绿组和台盼蓝组分别为96．7％、100％。尚未观察到术后染色剂残存于眼组织或人工晶状体异色。术后矫正视力0．5～1．2。结论 生物活性染色剂可显著提高白色白内障超声乳化手术的安全性。     

Posterior capsule staining and posterior continuous curvilinear capsulorhexis in congenital cataract

We report 2 cases of indocyanine green (ICG) staining used for posterior continuous curvilinear capsulorhexis (PCCC) in congenital cataract combined with anterior vitrectomy. In the first case, because of corneal opacity, the visibility of the posterior capsule was poor without staining. After the extraction of the cataract, a PCCC was performed after ICG staining of the posterior capsule. In the second case, after cataract removal, ICG staining was used to better visualize the posterior capsule. In both cases, the PCCC was successfully completed because of better visualization of the stained posterior capsule flap against the transparent anterior hyaloid face of the vitreous. Clear visual axes have been maintained.     

Time course of lens capsule staining using trypan blue and indocyanine green: in vitro study in porcine eyes

PURPOSE: To determine whether staining of the lens capsule with trypan blue 0.1% and indocyanine green (ICG) 0.5% diminishes with time and whether it differs between the anterior and posterior capsules. SETTING: Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan. METHODS: Crystalline lenses removed from porcine eyes were stained for 10 seconds with 0.1 mL of trypan blue 0.1% or indocyanine green 0.5%. They were then placed in distilled water and observed for the persistence of staining over time. In a second experiment, the anterior chamber and internal aspects of the anterior capsule and internal and vitreous aspects of the posterior capsule were gently irrigated with 0.1 mL of trypan blue 0.1% or ICG 0.5%. After 10 seconds, the capsules were irrigated with distilled water and the staining intensities were compared. RESULTS: Staining was not diminished 30 seconds, 5 minutes, or 1 hour after application of either dye. No difference was evident in staining intensity or diminution with time between the anterior and posterior capsules, but the external aspects were stained more than the internal aspects with both dyes. Trypan blue produced more intense staining than ICG. CONCLUSIONS: Since the intensity of capsule staining in the intact lens did not change during a 1-hour immersion in water, capsule dyes may not dissipate fully during cataract surgery. As possible long-term adverse effects have not been ruled out, capsule dyes should be used in a low concentration for a short exposure time.     

白内障手术连续环形撕囊的染色技术

目的:观察VisionBlue（0.06％台盼蓝）染色在白色白内障超声乳化手术中是否有助于连续环形撕囊（CCC）及整个手术安全顺利进行。方法:30例30只眼,术中前房注入0.1ml VisionBlue,观察前囊膜着色效果、撕囊成功率、在超声乳化手术中囊膜保护的完整率以及角膜内皮、眼压和房水炎症反应等。结果:28眼前囊膜周边及中央一次性均匀着色,2只眼经过两次染色后着色均匀;撕囊全部成功顺利,在后续的超乳手术中保留的囊膜边界清晰,完整率30/30;术中无并发症,术后视力提高,炎症反应轻,眼压及角膜内皮与术前无统计学差异;追踪3个月未见明显副作用。结论:VisionBlue染色是一种简单安全的技术,提高了前囊膜的可见度,有助于白色白内障超声乳化手术CCC和整个手术的安全顺利进行。     

Intracameral triamcinolone helps to visualize and remove the vitreous body in anterior chamber in cataract surgery

AIM: To study the effects of intracameral injection of triamcinolone acetonide on visualizing and removing the vitreous body from the anterior chamber in cataract surgery. DESIGN: Observational case series. METHODS: Six eyes of six patients had the posterior capsule ruptured and the vitreous body prolapsed or incarcerated into the anterior chamber during cataract surgery. To visualize vitreous body, triamcinolone acetonide solution was injected into the anterior chamber and the vitreous body was resected. The intraoperative findings, results, and complications were evaluated. RESULTS: Vitreous body was well observed under surgical microscopy and was resected safely and completely. Minimum inflammation was observed postoperatively, and the patients obtained good visual acuity. No serious complications were found. One eye showed increased intraocular pressure (40 mm Hg), which was normalized by additional washing of the anterior chamber. CONCLUSIONS: Appropriate use of intracameral triamcinolone acetonide is beneficial to visualize and remove the vitreous body from the anterior chamber during cataract surgery, and sufficient washing of the anterior chamber is necessary to avoid complications.     

吲哚青绿前囊膜染色在白色白内障连续环形撕囊术中的应用

目的：探讨0.5%吲哚青绿溶液前囊膜染色在白色白内障环形撕囊术中提高前囊膜能见度的有效性，安全性及其手术技巧。方法：共30例白色白内障患者接受了0.5%吲哚青绿溶液囊膜染色，采用前房气泡下染色法，27号钝针头抽取0.5%吲哚青绿溶液0.1ml，自辅助切口注入到前囊膜中央表面，留置30秒，平衡盐液置换出空气和多余染料，应用撕囊镊完成连续环形撕囊操作。结果：经0.5%吲哚青绿溶液染色后30例白色白内障的前囊膜呈现均匀的淡绿色，能见度显著提高。撕囊成功率96.7%。术后裂隙灯显微镜下未见染料颗粒残存。未见与染色有关的角膜内皮受损，虹膜炎及眼丈夫升高等并发症。结论：0.5%吲哚青绿溶液前囊膜染色可安全有效地应用于白色白内障环形撕囊术中，但需注意吲哚青绿溶液的配置方法和撕囊操作技巧。     

Comparison of dyes for cataract surgery. Part 2: efficacy of capsule staining in a rabbit model

PURPOSE: To investigate the efficacy of various dyes for anterior capsule staining to facilitate capsulorhexis during cataract surgery. SETTING: Department of Ophthalmology and Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan. METHODS: Various concentrations of indocyanine green (ICG), methylene blue (MB), gentian violet (GV), trypan blue (TB), and fluorescein sodium (FS) were used to stain rabbit lenses in vitro. After 1 minute of exposure, the staining of each lens was evaluated using a semiquantitative scoring system in which 0 represented no staining/no contrast between the capsule and cortex and 4 represented excellent staining/remarkable contrast between the stained capsule and unstained cortex. The lowest concentration of dye with a score of 4 was considered the lowest effective concentration for capsulorhexis. RESULTS: Based on our scoring system, the lowest effective concentrations for capsulorhexis were ICG 0.25%, MB 0.10%, GV 0.01%, TB 0.10%, and FS 1.25%. The lowest effective concentrations of the 5 dyes provided comparable contrast. Increased concentrations of dye decreased contrast between the capsule and the cortex and were considered less effective for capsulorhexis. CONCLUSION: Any of the following concentrations of dyes can be used for optimal enhancement of anterior capsule visibility for capsulorhexis: ICG 0.25%, MB 0.10%, GV 0.01%, TB 0.10%, and FS 1.25%.     

吲哚青绿在白色白内障超声乳化吸除术中的应用

目的　评价吲哚青绿在白色白内障超声乳化吸除术中应用的有效性和安全性。方法对 10 5例 (10 5只眼 )白色老年性白内障患者行超声乳化白内障吸除术 ,Ⅰ组 (5 5只眼 )术中使用 0 5 %吲哚青绿溶液染色晶状体前囊膜 ;Ⅱ组 (5 0只眼 )术中不使用染色剂。记录术中完成连续环形撕囊(CCC)的时间 ,晶状体前囊膜放射状撕裂、晶状体囊袋破裂、人工晶状体囊袋内固定情况 ,以及术前、术后 1d、术后 3个月术眼眼压 ,角膜内皮变化和眼前节炎性反应情况。结果　术中平均CCC时间Ⅰ组明显短于Ⅱ组 ,晶状体前囊膜放射状撕裂和晶状体囊袋破裂的发生率Ⅰ组明显低于Ⅱ组 ,人工晶状体囊袋内固定率Ⅰ组高于Ⅱ组 ,两组比较差异均有显著意义 (P <0 0 5 )。两组术后均无眼压升高者 ,角膜始终保持透明 ,炎性反应轻微 ;手术前、后角膜内皮细胞密度、六角形细胞百分比、面积变异系数及中央角膜厚度两组比较 ,差异均无显著意义 (P >0 0 5 )。结论　在白色白内障超声乳化吸除术中应用吲哚青绿晶状体前囊膜染色技术 ,可提高手术的成功率 ,且效果安全、可靠 ,建议临床推广使用。     

染色剂辅助撕囊技术在白内障超声乳化术中的应用

目的 :探索对于一些缺乏眼底红光反射的白内障 ,采用染色剂蓝域辅助撕囊技术完成连续环行撕囊 (CCC)的超声乳化术手术效果。方法 :78例 (86只眼 )行白内障超声乳化术的患者 ,分成染色剂辅助撕囊组 (A组 ) 36例 (42只眼 ) ,和常规手法撕囊组 (B组 ) 4 2例 (44只眼 )结果 :(1)连续环行撕囊成功者 ,在A组为 97 4 6 % (41/4 2 ) ,在B组为 6 8 18% (30 /4 4 ) ;两组差异具极显著性意义 (P <0 0 1)。 (2 )A组中 ,2只眼出现前囊膜向赤道部撕裂 ,但未造成后囊破裂 ;B组中 ,8只眼发生后囊破裂及部分玻璃体脱出 ,需要行前段玻璃体切割术。结论 :染色剂辅助撕囊技术 ,对于一些缺乏眼底红光反射的白内障患者 ,可以明显提高连续环行撕囊的成功率 ,从而使这类患者的超声乳化术更加安全。     

晶状体前囊膜苔盼蓝染色在白内障超声乳化术中的临床应用观察

目的 探讨晶状体前囊膜染色技术在白内障超声乳化术中应用的有效性和安全性。方法 88例（90只眼）行白内障超声乳化术患者,分成染色剂辅助撕囊组A组40例（40只眼）,和常规手法撕囊组B组40例（40只眼）,观察撕囊成功率、在超声乳化手术中囊膜保护完整率以及眼压和房水炎症反应等。结果 连续环形撕囊成功者,A组为95％（38／40）,B组为62．50％（25／40）;A、B两组中,分别有2只眼及10只眼出现前囊膜向赤道部撕裂,并行前段玻璃体切割术。结论 染色剂辅助撕囊技术,对于一些缺乏眼底红光反射的白内障患者,可以明显提高连续环形撕囊的成功率,使这类患者的超声乳化术更加安全。     

台盼蓝囊膜染色剂在白内障连续环形撕囊手术中的应用

目的研究台盼蓝囊膜染色剂在治疗白色白内障中,是否有助于连续环形撕囊的顺利完成及白内障手术的顺利进行。方法79例(80眼),随机分为2组,染色组40例(41眼),对照组39例(39眼),染色组使用台盼蓝囊膜染色剂,术中观察及对比前囊膜染色情况、连续环性撕囊成功率、晶状体后囊破裂及人工晶状体囊袋内植入情况,术后视力、前房炎症反应、角膜、人工晶状体有无蓝染及后囊混浊情况。并与对照组进行统计学分析。结果染色组的术中染色均匀,连续环形撕囊及人工晶状体囊袋内植入率为97.7%,晶状体后囊破裂率为2.44%,与对照组进行统计学分析有显著差异。术后追踪观察3个月,染色组术后视力好于对照组,前房炎症反应、晶状体后囊混浊2组无统计学差异。染色组术后角膜、人工晶状体未见蓝染,未见术中及术后并发症。结论台盼蓝囊膜染色剂目前是一种安全可靠的技术,手术中可以看清前囊,使连续环形撕囊顺利进行,人工晶状体稳定的位于囊袋内,增加了白色白内障手术的成功率。     

Anterior and posterior capsulorhexis in pediatric cataract surgery with or without trypan blue dye: randomized prospective clinical study

PURPOSE: To evaluate the clinical efficacy of trypan blue 0.1% dye (Blurhex) in creating a complete anterior and posterior capsulorhexis during pediatric cataract surgery. SETTING: Tertiary eyecare center, Postgraduate Institute of Medical Education and Research, Chandigarh, India. METHODS: In a prospective randomized study, an anterior (ACCC) and posterior (PCCC) continuous curvilinear capsulorhexis were performed in pediatric patients. In Group 1 (n = 19), the ACCC and PCCC were created without use of trypan blue dye. In Group 2 (n = 23), intracameral trypan blue dye was used to stain the anterior and posterior capsules. RESULTS: In Group 1, 14 eyes (73.6%) had a complete ACCC and 10 (52.6%) had a complete PCCC. In Group 2, 21 eyes (91.3%) had a complete ACCC and 19 (82.6%) had a complete PCCC. CONCLUSION: In cases of pediatric cataract, staining the anterior and posterior capsules with trypan blue 0.1% allowed recognition of capsule flaps and facilitated the creation of complete ACCCs and PCCCs.     

晶状体前囊染色在白内障手术中的应用

目的 探讨晶状体前囊染色在白内障手术中应用。方法 在６５２眼白内障摘出术中,采用０．５％吲哚青绿溶液进行晶状体前囊染色后,实施连续环形撕囊术或截囊术。结果 所有病例在吲哚青绿溶液注入前房后,晶状体前囊染成浅绿色,在手术显微镜下清晰可辨,使撕囊或截囊术得以快速顺利完成,并且不干扰其他手术步骤进行,术后无不良反应。结论 吲哚青绿溶液晶状体囊染色有助于白内障手术中辨认晶状体前囊。