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Capsular staining aids in visualization of capsulorrhexis
Indocyanine green reduced the risk of intraoperative complications by providing adequate illumination of the lens during pediatric cataract surgery.
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Staining the anterior capsule with indocyanine green enhanced visualization of the capsulorrhexis during pediatric cataract surgery in a study at the New Jersey Medical School.
“ICG provides superior visualization of the anterior capsule and is useful in adult cataracts, particularly if there is an opaque capsule,” Rudolph S. Wagner, MD, of the Institute of Ophthalmology and Visual Science in Newark, N.J., told Ocular Surgery News.
Indocyanine green (ICG) is a pharmacological dye. When applied to the anterior lens capsule during cataract surgery, ICG provides enhanced visualization in eyes with opaque cataracts and the absence of red reflex.
According to researchers, ICG helps limit the risk of capsular tears and other complications associated with the creation of a continuous curvilinear capsulorrhexis during removal of white cataracts in pediatric or adult patients.
“From our experience in the management of adult mature cataracts, an ICG-enhanced continuous curvilinear capsulorrhexis is superior to fluorescein or the light pipe illumination technique,” Dr. Wagner and co-authors reported in the Journal of Pediatric Ophthalmology & Strabismus.
Similar results were found in a pediatric population, the authors reported.
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Study methods
Ten eyes of four boys and two girls between the ages of 4 and 9 underwent ICG staining of the lens capsule before cataract surgery. Four patients had bilateral cataracts, and two patients had unilateral cataracts. All patients presented with dense cataract and poor red reflex.
Patients underwent preoperative eye examinations consisting of cycloplegic refraction, slit lamp examinations and fundus examinations including A- and B-scan readings. No additional ocular abnormalities were found. Visual acuity was 20/200 to hand motions.
Initially, researchers used light pipe illumination as the control method of illumination in four eyes. However, when light pipe illumination failed to enhance the visualization of the anterior capsule for surgery, all eyes underwent ICG-enhanced cataract surgery.
ICG administration
Surgeons stained the anterior capsule 3 clock hours before phacoemulsification. ICG solution was injected through a side-port paracentesis incision.
“A large air bubble was injected into the anterior chamber using a 30-gauge cannula. ICG solution [0.125%] was spread onto the anterior lens capsule and under the bubble via a 30-gauge cannula,” the authors reported. Viscoelastic was injected into the lens after ICG staining was complete.
Standard cataract surgery then proceeded. In three uncooperative patients under age 6, a primary posterior capsulorrhexis and anterior vitrectomy were performed before ICG-enhanced cataract surgery and IOL implantation, the authors noted.
Enhanced visualization
Researchers reported that ICG staining enhanced visualization of the lens capsule significantly. “Visualization was significantly enhanced during the capsulorrhexis in all 10 eyes with dense cataracts,” the study authors reported. “An ICG-enhanced capsulorrhexis was then successfully completed in these eyes.”
They noted that the application of ICG also aided in guarding against posterior capsular opacification.
“ICG staining enhances the visualization of residual lens epithelial cells on the rim of the anterior capsule, which may improve cleaning off these cells and prevent or delay posterior capsular opacification,” the authors said.
No complications were reported postoperatively. Patients achieved an average visual acuity of 20/40.
For Your Information:
- Rudolph S. Wagner, MD, is director of pediatric ophthalmology, UMDNJ-New Jersey Medical School, Newark, Children’s Eye Care Center of New Jersey. He can be reached at 495 North 13th St., Newark, NJ 07107; 973-485-3186; fax: 973-497-5674; e-mail: wagdoc@comcast.net.
Reference:
- Guo S, Caputo A, Wagner R, DeRespinis P. Enhanced visualization of capsulorhexis with indocyanine green staining in pediatric white cataracts. J Pediatr Ophthalmol Strabismus. 2003;40:268-271.