Edward F Smith, Rajen U Desai, Amilia Schrier
Jul 1, 2010
Citations
0
Influential Citations
2
Citations
Quality indicators
Journal
Ophthalmology
Abstract
Dear Editor: Despite the widespread use of Trypan Blue (D.O.R.C. International, Zuidland, the Netherlands) as an adjunct to stain the anterior capsule, evidence to support its use in nonmature cataracts is, nevertheless, largely anecdotal. In the Opththalmic Technology Assessment “Capsule staining as an adjunct to cataract surgery: A Report from the American Academy of Ophthalmology,” by Jacobs et al., the authors concluded that there is Level II (i.e., well-designed cohort and case-controlled studies) evidence that capsular dye staining may be helpful in surgeries for pediatric and white cataracts. However, for nonmature cataracts, the authors conclude that the overall surgical advantage has not yet been demonstrated. Moreover, Akman and Akova argued that a red reflex is sufficient for capsulorhexis, and that Trypan Blue, instead, complicates the procedure by reducing the color and contrast differences of the lens and stained capsule. To address the concerns of Jacob et al., and to test our hypothesis that Trypan Blue provides a surgical benefit, we present the first randomized, controlled, prospective, clinical study of the use of Trypan Blue as an adjunct in surgeries of nonmature cataracts with a good red reflex. The candidate eyes included the first 20 cataract extraction cases of each of our 7 senior residents: 10 which were performed with Trypan Blue and 10 without Trypan Blue. The sequence for the use of the dye was predetermined by a random number generator for each resident. Among these initial 140 cases, 117 cases (from 112 patients) met our inclusion criteria: planned primary phacoemulsification cataract surgery, best-corrected visual acuity 20/70 to 20/200, pupillary dilation 6 mm or larger, moderate to good red reflex, and a cataract consisting of at least 2 nuclear sclerosis. Of these cases, 67 cases received Trypan Blue while 50 cases served as controls. For the eyes assigned to receive Trypan Blue, 0.1 ml of VisionBlue (0.06% Trypan Blue ophthalmic solution) was injected directly on top of the anterior lens capsule and under an air bubble prior to performing capsulorhexis. After 5 seconds of staining, the anterior chamber was irrigated using balanced saline solution through the paracentesis. Thereafter, Viscoat (Alcon Laboratories, Fort Worth, TX) was used to fill the anterior chamber. In the control group, no air bubble or dye was used, and only Viscoat was injected into the anterior chamber. In both groups, the resident surgeon used a cystotome, followed by utrata forceps, to create a capsulorhexis (Figure 1; available at http:// aaojournal.org). Attending surgeons were instructed to only intervene if the capsulorhexis advanced beyond the pupil edge and was