Dye-enhanced cataract surgery. Part 1: anterior capsule staining for capsulorhexis in advanced/white cataract

To evaluate anterior capsule staining using 3 dyes to perform continuous curvilinear capsulorhexis (CCC) in postmortem human eyes with advanced/white cataract.

Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA.

In experimental closed-system surgery, CCC was performed in 12 postmortem human eyes with cataract after the anterior capsule was stained with 3 capsule dyes (fluorescein sodium 2%, indocyanine green [ICG] 0.5%, and trypan blue 0.1%). Two commonly used techniques for capsule staining were also compared: staining within an air bubble and intracameral subcapsular injection of dye.

In all globes, CCC was uneventful using the 3 dyes and with both techniques. With the intracameral subcapsular injection, the dye remained trapped in the subcapsular space in contact with the posterior surface of the anterior capsule, allowing enough time to perform any maneuver. The staining provided by ICG, at the concentration used, was slightly superior to that of the other dyes. Leakage of fluorescein sodium into the vitreous cavity was seen using the Miyake-Apple posterior video/photographic technique.

Intracameral subcapsular injection of ICG allowed the easiest recognition of the capsular flap by staining the posterior surface of the anterior capsule and without leaking into the vitreous cavity.