Corneal edema and permanent blue discoloration of a silicone intraocular lens by methylene blue.

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.     

Digital image analysis of trypan blue and fluorescein staining of anterior lens capsules and intraocular lenses

PURPOSE: To study the intensity of trypan blue and fluorescein staining over time in anterior lens capsules and various intraocular lens (IOL) materials. SETTING: Fritz Eye Associates, Geislingen, Germany. METHODS: Excised anterior lens capsules and IOLs were exposed to trypan blue 0.1% and fluorescein 2% solution to assess the time correlation of color saturation. A technique of color differentiation using red-green-blue analysis was used. RESULTS: In the anterior lens capsules, trypan blue saturation was 17% after 60 seconds and 71% after 24 hours; with fluorescein, there was no visible staining after 5 minutes and 17% saturation after 24 hours. Red and green light transmission was reduced with trypan blue and high with fluorescein. Blue light transmission was reduced with fluorescein. In poly(methyl methacrylate) and silicone IOLs, there was no to minimal staining and in acrylic IOLs, there was intense uptake of both dyes. CONCLUSIONS: The implications of this surgical technique are to use a short exposure time with trypan blue and avoid acrylic IOLs in cases of questionabale dye loss to the vitreous. Fluorescein should be used as a dye only when injected subcapsularly.     

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。     

Effect of blue staining of expandable hydrophilic intraocular lenses on contrast sensitivity and glare vision

PURPOSE: To evaluate the effect of trypan blue staining of expandable hydrophilic acrylic intraocular lenses (IOLs) on contrast sensitivity and glare. SETTING: Department of Ophthalmology, Federal University, and Oculistas Associados, Rio de Janeiro, Brazil. METHODS: Phacoemulsification with expandable hydrophilic IOL implantation was performed in 19 eyes. Group 1 (stained group) consisted of 12 eyes with the IOL unintentionally stained by trypan blue 0.1% solution during surgery; Group 2 (unstained group) consisted of 7 eyes with IOLs that were not stained because trypan blue was not used during surgery. The eyes were examined postoperatively for Snellen best corrected visual acuity (BCVA), contrast sensitivity BCVA, and glare vision. The examiners were masked to whether the IOL was stained by trypan blue. Inclusion criteria included a BCVA of 20/30 or better 1 month postoperatively. Patients who had other ocular pathology or previous ocular surgery were excluded from the study. RESULTS: The mean postoperative BCVA was 20/24 in the stained group and 20/23 in the unstained group (P =.73). The mean contrast sensitivity visual acuity was 20/31 in the stained group and 20/26 in unstained group (P =.10). The mean glare visual acuity was 20/75 and 20/33, respectively (P =.03). CONCLUSIONS: Patients with expandable hydrophilic acrylic IOLs stained with trypan blue performed significantly worse on a glare vision test than patients whose IOLs were not stained. Cataract surgeons should avoid using trypan blue with this IOL type.     

低浓度台盼蓝囊膜染色技术在白内障手术中的应用

目的：探讨台盼蓝染色晶状体前囊膜的最低有效浓度,评价白内障手术中应用囊膜染色技术的临床意义。

方法：收集2014-03/2016-12成熟期年龄相关性白内障患者60例60眼,晶状体皮质混浊程度为C4～C5、核混浊程度为N3(以晶状体混浊分类系统Ⅱ为标准),随机分为三组。三组患者术中分别使用0.03%、0.015%和0.0075%三种不同浓度台盼蓝。所有患者均由同一经验丰富手术医生完成手法小切口白内障手术。术中观察前囊膜染色情况以及撕囊难易程度。记录连续环形撕囊术(continuous circular capsulorhexis,CCC)成功、后囊袋破裂以及人工晶状体囊袋内植入情况。观察术后1d,1wk,3mo术眼角膜内皮细胞计数、眼压、前房炎症反应、角膜水肿和眼内结构染色情况。

结果：浓度低至0.015%的台盼蓝仍可对晶状体前囊膜有效染色,顺利完成CCC。0.03%与0.015%两组患者CCC成功率和IOL囊袋内植入率均高于0.0075%组,差异均有统计学意义(P<0.0083)。三组患者后囊破裂发生率和角膜内皮细胞平均损失率两两比较,差异均无统计学意义(P>0.0083)。术后晶状体前囊撕囊口边缘及侧切口的着染均于1wk内消失,未见其他眼内结构蓝染,前房炎症反应轻,未发现超过1wk的角膜水肿和眼压升高。

结论：白内障手术中应用台盼蓝晶状体前囊膜染色技术安全有效,可提高手术成功率,建议使用台盼蓝最低有效浓度为0.015%。     

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.     

Opacification of hydrophilic MemoryLens U940A intraocular lenses: analysis of 2 explanted lenses

PURPOSE: To determine the rate of opacification of hydrophilic MemoryLens U940A intraocular lenses (IOLs) (Mentor Ophthalmics, Inc.) in the given cohort and perform a histopathological and spectrophotometer analysis of 2 explanted opacified IOLs. SETTING: Ophthalmology Department, Faculty Hospital, Nitra, Slovakia. METHOD: This retrospective study comprised 182 patients (205 eyes) who had implantation of a MemoryLens U940A IOL from June 1997 to June 2000. The patients were examined using a slitlamp to detect the presence of IOL opacification. In 4 cases, the lenses were explanted because of significant opacification and patient-reported problems; 2 lenses were provided for further analysis. One unused reference MemoryLens U940A IOL was also evaluated. All IOL were stained with von Kossa to determine the presence of calcium in the opacification. To confirm the components presence of an ultraviolet (UV) absorber, the IOLs were examined with an Avatar 330 Fourier transfer infrared (IR) spectroscope and a UV visible spectrophotometer (Philips). The IR spectrums for the IOL were identified using an IR spectrum atlas. The opacified IOLs, reference IOL, and the IOL packaging were further examined to determine the presence of silicone. RESULTS: Various amounts of opacification were found on the MemoryLens U940A IOL in 30 eyes (30 patients) (14.63%). Two explanted IOLs were positive for von Kossa staining, proving the presence of calcium deposits; the reference lens staining was negative. Spectrophotometry showed that the reference IOL and opacified IOLs were of the same polymer. The presence of the UV absorber on the benzophenone base was seen in the reference lens but not the opacified IOLs. In contrast, an increased concentration of low-molecular-weight components generated during the degradation of the polymer was present in the opacified lenses. The white cover pf the IOL is of polydimethyl siloxane, a silicone rubber. However, no silicone rubber was present in any examined lens, perhaps because the IOLs were in contact with alcohol during the histopathologic examination. CONCLUSIONS: The results indicate opacification of the hydrophilic MemoryLens U940A was caused by premature consumption of the UV absorber in the polymer component of the IOLs optic, with a subsequent degradation of the polymer. Whether silicone from the white cover led to the IOL opacification, as reported with other types of hydrophilic IOLs, could not be confirmed.     

白内障手术中苔盼蓝晶状体囊染色的作用及安全性

目的观察苔盼蓝作晶状体囊染色在超声乳化术中应用的有效性和安全性。方法回顾分析使用晶状体苔盼蓝染色剂Vision Bule前后两个时期的晶状体全浑浊的白内障手术186例（212眼）。其中96例（118眼）使用了染色剂。对术中操作和术后效果进行了对比。结果晶状体囊苔盼蓝染色剂Vision Blue对晶状体前囊有较好的染色效果,可使手术操作变得安全易行,术中术后无不良反应。结论晶状体囊染色剂Vision Blue在超声乳化术中对晶状体前囊染色的应用是有效的和安全的。     

台盼蓝囊膜染色剂在复明工程成熟期白内障手术撕囊中的应用

目的 探讨台盼蓝囊膜染色剂在白内障复明工程白内障手术撕囊中的应用价值。设计 回顾性比较性病例系列。研究对象 2012-2013年期间河北省兴隆县人民医院“百万贫困白内障患者复明工程” 成熟期或过熟期白内障手术患者84例（84眼）。方法 随机分为观察组和对照组,每组42例（42眼）。观察组超声乳化白内障手术过程中接受0.1 ml 0.1%台盼蓝磷酸盐缓冲溶液前囊膜染色后行连续环形撕囊,对照组超声乳化白内障术中撕囊前未予染色。主要指标  术中囊膜染色情况,撕囊成功率,术后视力、眼压、前房炎症反应、角膜水肿及后囊混浊情况。结果 观察组台盼蓝染色后,晶状体前囊膜100%被染成淡蓝色。撕囊成功率观察组97.6%,对照组78.6%（P=0.003）;术后1个月视力、眼压、前房炎症反应、角膜水肿情况两组比较差异无统计学意义（均为P>0.05）;术后3个月后囊膜明显混浊观察组1/42例、对照组6/42例（P=0.027）。结论 白内障复明工程成熟期或过熟期白内障手术中采取台盼蓝囊膜染色剂行前囊膜染色,使连续环形撕囊相对容易,保证手术更顺利进行。（眼科,2014,23：271-273）     

Imaging characteristics of delayed surface calcification in hydrophilic intraocular lens models

We report two cases of opacified explanted intraocular lenses (IOL).The first lens was explanted from a cataract patient, then treated in vitro with trypsin/ethylene-diamine-tetra-acetic acid. The second hydrophilic acrylic IOL was explanted from a patient who had undergone sulphur hexafluoride (SF₆) gas endotamponade surgery to repair a retinal detachment.     

Traumatic cataract surgery assisted by trypan blue.

The advantages of trypan blue use in anterior segment surgery have been well recognized, but few reports of its use in traumatic cataract surgery have been published. The authors describe three cases of traumatic cataract in which the role of trypan blue in performing safe and successful cataract surgery is demonstrated. Selective staining of the anterior lens capsule using trypan blue enabled the surgeon to identify the extent of structural damage and plan the surgery accordingly. In all three cases, the cataract was removed and the intraocular lens was implanted successfully without complications. Trypan blue is a safe and helpful aid in traumatic cataract surgery.     

台盼蓝在白色白内障超声乳化术中的应用

目的 探讨台盼蓝对晶状体前囊染色在白色白内障手术中应用效果。方法82例87眼随机分为染色组43例46眼与对照组39例41眼，染色组术中用台盼蓝染色，观察前囊膜着色效果、撕囊成功率、在超声乳化术中囊膜保护的完整率以及术中、术后并发症等，并与对照组进行统计学分析。结果染色组前囊膜均均匀着色，撕囊成功率与术中囊膜完整率均为100％，与对照组比较有明显统计学差异；术后视力、眼压、炎症反应、角膜内皮水肿与对照组比较无统计学差异。结论台盼蓝染色是一种简单安全的晶状体前囊膜染色技术，提高了前囊膜的可见度，有助于白色白内障超声乳化术连续环形撕囊术(continuous curvilinear capsulorhexis,COC)和整个手术的顺利进行。     

Opacification of hydrophilic acrylic intraocular lenses: a clinical and ultrastructural analysis of three explanted lenses

BACKGROUND: The purpose of our study was to report the clinical and ultrastructural results of the late opacification of three Hydroview intraocular lenses (IOLs) explanted from three patients with late postoperative visual acuity drop. PATIENTS AND METHODS: Three different patients without any systemic or ocular associated pathology presented with decreased visual acuity 12 to 24 months after uneventful phacoemulsification and Hydroview IOL implantation. The lenses were explanted and examined by photon and transmission electron microscopy (TEM), as well as through laboratory chemical analysis using bleaching with H 2 O 2, SDS-electrophoresis and silver staining for protein detection. They were cut in small pieces, fixed with osmium tetroxide 1.5 %, dehydrated through ascending grades of ethanol, and embedded in EPON 812. Ultrathin sections were stained with aqueous solutions of uranyl acetate and lead citrate, and they were examined with JEOL 2000 CX TEM. One normal IOL was also prepared in the same way and served as control. RESULTS: Control: It was transparent and no material on the surface of semithin and thin sections was detected. Cases 1 and 2: A total gray-whitish opacification of these lenses occurred. An amorphous loose material was present on semithin sections in alternation with normal areas. Evaluation with TEM revealed a pattern of network distribution within the lenses material. The latter was continuous and lightly granulated at the periphery, yet irregularly arranged in the center, more intensely stained, leaving areas of normal appearance. After bleaching, no changes in opacification were seen macroscopically. SDS-electrophoresis and silver staining did not detect proteins. Case 3: This lens had a small opacification close to the periphery. CONCLUSIONS: Late opacification of hydrophilic IOLs is not an uncommon phenomenon after uneventful cataract surgery. Although calcified deposits on the surfaces of such lenses have been reported, this is the first study that describes ultrastructural changes in the IOL material itself.     

Trypan blue capsular staining to "find" the leading edge of a "lost" capsulorhexis

PURPOSE: To describe an effective surgical technique to visualize an obscured leading edge of a capsulorhexis. DESIGN: Prospective, interventional case series. METHODS: In six eyes of six patients in which the capsulorhexis was started but could no longer be seen during surgery, the anterior chamber was irrigated to remove all viscoelastic, and 0.3-ml trypan blue 0.06% was applied onto the anterior lens capsule to stain and visualize the leading edge of the capsulorhexis. RESULTS: In all patients, the leading edge of the capsulorhexis was quickly visualized by using the dye. No adverse reactions were observed up to 1 year after surgery. CONCLUSION: Trypan blue staining of the anterior lens capsule is an effective and apparently safe technique to "find" a "lost" capsulorhexis during surgery.     

Unintentional staining of the posterior lens capsule with trypan blue dye during phacoemulsification: case report

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.     

台盼蓝与吲哚青绿在成熟期和过熟期白内障手术中的应用

目的：：观察台盼蓝与吲哚青绿在成熟期、过熟期白内障超声乳化手术中进行连续环形撕囊( continuous curvilineal capsulorrhexis, CCC)的作用及效果。方法：选取成熟期、过熟期白内障122例122眼,随机分为3组,台盼蓝染色组( A组)46例46眼,吲哚青绿染色组(B组)40例40眼,对照组(C组)36例36眼。染色组在手术中分别使用台盼蓝或吲哚青绿0.2mL注入前房,进行CCC。术中观察及对比连续环形撕囊成功率、晶状体后囊破裂及人工晶状体囊袋内植入情况。观察术后前房炎症反应,并与对照组进行观察分析。结果：台盼蓝染色组(A组)连续环形撕囊成功率、人工晶状体囊袋内植入率与对照组(C组)进行统计学分析有显著性差异(P<0.05)。吲哚青绿染色组(B组)人工晶状体囊袋内植入率与对照组(C组)进行统计学分析有显著性差异(P<0.05)。晶状体后囊破裂率三组间无显著性差异(P>0.05)。术后观察前房炎症反应三组间无明显差异。结论：应用台盼蓝或吲哚青绿对缺乏红色反光的成熟期、过熟期白内障进行晶状体囊膜染色后再行CCC,目前是一种安全可靠的技术,两者效果相当。手术中可以使连续环形撕囊顺利进行,提高了手术成功率。     

Open-sky capsulorrhexis in triple procedure: with or without trypan blue?

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.     

Complications with foldable intraocular lenses with subsequent explantation in 1998 and 1999. Results of a questionnaire evaluation

Purpose. A questionnaire was sent to all members of the German Society of Ophthalmic Surgeons to evaluate complications of foldable intraocular lenses (IOLs) that required explantation. Methods. Information on preoperative visual acuity, foldable IOL design and material as well as the reason for IOL explantation was obtained and analysed. We received 167 completed questionnaires for 1998 and 1999. Results. In 1998 and 1999 the most common reasons for IOL explantation were as follows: incorrect lens power for 56% of the 3-piece hydrophobic acrylic IOLs, 16% because of glare or other photic phenomena, 40% of the 1-piece hydrophilic acrylic IOLs were explanted because of incorrect lens power and 30% for IOL damage. For the 3-piece monofocal silicone IOLs, 41% were explanted because of incorrect IOL power and 32% because of IOL decentration. For the 1-piece Hydrogel IOL, 76% were explanted because of opacification of the optic and 14% because of incorrect lens power. Most multifocal IOLs were explanted because of photic phenomena. Conclusion. In addition to the most common complications such as decentration and incorrect IOL power observed in rigid IOLs, new complications associated with foldable IOLs occurred such as optic opacification, glare and photic phenomena. Some complications seemed to appear in particular IOL types (opacification: SC-60BOUV, MDR), while others were observed in all types of foldable lenses. Accurate calculation of the IOL power and further improvement of the IOL material and design seem to be necessary to minimise the rate of explantations.     

Perioperative complications and clinical outcomes of intraocular lens exchange in patients with opacified lenses

Background

To evaluate the perioperative complications and the outcomes of intraocular lens (IOL) exchange in patients with opacified lenses.

Methods

Retrospective multicentrical consecutive series of cases that comprised 22 eyes from 21 patients who had previous phacoemulsification with implantation of an IOL in the capsular bag and developed severe late opacification of the IOL. All patients had loss of vision and reported light disturbances. The IOLs were explanted and replaced with new IOLs. The perioperative complications were evaluated. The best spectacle-corrected visual acuity (BSCVA) before and after the surgery was compared.

Results

The mean time lapsed between the original cataract surgery and the IOL exchange surgery was 89.1?±?33.6 [48–216] months. The IOL exchange was uneventful in 14 eyes (63.6 %). Anterior vitrectomy was needed in seven cases (31.8 %). Other complications included zonular dehiscence in one case (4.5 %). In most of the cases, 14 eyes (63.6 %), the IOL was implanted in the sulcus. The most explanted IOL was the Hydroview H60M (Bausch & Lomb). The mean BSCVA (LogMAR) before and after the surgery were 0.57?±?0.69 (0.10–3) and 0.18?±?0.22 (0.0–1.10) respectively (t paired test, p?<?0.001). After the operation, 20 eyes (90.9 %) achieved a BSCVA?≤?0.3. No eye lost 1 or more lines of corrected vision after the surgery.

Conclusions

IOL exchange surgery, although associated with a high incidence of complications, restores and significantly improves the visual acuity of patients with opacified IOLs.     

Biomechanical changes in the anterior lens capsule after trypan blue staining

PURPOSE: To examine the effect of trypan blue staining on the biomechanical behavior of the porcine anterior lens capsule. SETTING: Department of Ophthalmology, Technical University of Dresden, Dresden, Germany. METHODS: Fifty-five anterior lens capsules from porcine cadaver eyes were used. Two parallel 8.0 mm x 4.0 mm large capsule strips were prepared from each capsule. After trypan blue staining for various time intervals combined with exposure to white light (6000 lux) or with no light exposure, biomechanical stress-strain measurements were performed using an automated material tester. Untreated specimens and specimens treated with glutaraldehyde 0.1% were used as controls. The absorption spectrum of trypan blue 0.1% solution and the emission spectrum of the light source were measured. RESULTS: After treatment with light and trypan blue, at 25% strain, there was a statistically significant increase in stress of up to 70.1% and in elastic stiffness of 47% and a decrease in the ultimate mechanical strain of up to 13%. There were no biomechanical changes in capsules with trypan blue staining in the absence of light or after a short illumination time of 30 seconds, indicating a light-dependent process. After 30 minutes of glutaraldehyde 0.1% treatment, there was an increase in stress of 321.6% at 25% strain and a decrease in the ultimate strain of 47.6%. The emission spectrum of the light source included the absorption peak for trypan blue at 580 nm. CONCLUSIONS: Trypan blue staining of the lens capsule combined with light irradiation for at least 1 minute led to an increase in elastic stiffness at 25% strain and a reduction in the ultimate extensibility. This effect is probably due to the photosensitizing action of trypan blue, leading to light-induced collagen crosslinking of the capsule collagen similar to age-related crosslinking. Nucleus expression might be impeded by the increased capsule stiffness. Continuous curvilinear capsulorhexis is facilitated.