Viscoelastic technique aids trypan blue staining in mature cataracts

CHICAGO — Applying trypan blue dye to the anterior lens capsule with a modified soft-shell viscoelastic technique can aid in the performance of capsulorrhexis in mature cataracts, a speaker said here.

Capsulorrhexis can be challenging in advanced white or black cataracts because visualizing the capsule is difficult, said Steve A. Arshinoff, MD. Speaking here at the American Academy of Ophthalmology meeting, he described a modification of his ultimate soft-shell viscoelastic technique that he said facilitates staining of the capsule in these cases.

Dr. Arshinoff said the original method for trypan blue capsule staining described by Gerrit Melles, MD, involves injecting the dye into the anterior chamber under an air bubble and then washing it out. While this method successfully stains the capsule, it uses a large amount of dye and results in staining of other anterior segment structures, as well as possibly penetrating to the vitreous, he said.

In Dr. Arshinoff’s technique, before trypan blue is injected, the chamber is filled to about 90% with Healon5 (sodium hyaluronate 2.3%, Advanced Medical Optics). A space is left above the lens capsule, and into this space “a tiny bit” of dye is injected, he said.

“We paint trypan blue over the capsule with a tuberculin syringe and then wash out the excess with balanced salt solution,” Dr. Arshinoff said. “This avoids injecting too much dye and provides a crystal clear view for performing the capsulorrhexis.”

Dr. Arshinoff’s presentation was given during the symposium Spotlight on Cataract Surgery 2005, which featured interactive polling of the audience. During his presentation, the audience was asked, “What is your preferred dye for capsule staining?” The preferences were 13% for indocyanine green, 60% for the commercially available Vision Blue formulation of trypan blue from Dutch Ophthalmic International, and 27% for trypan blue formulated by a pharmacy.