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

Area of Science:

• Ophthalmology
• Surgical Techniques
• Corneal Surgery

Background:

• Triple procedures, including penetrating keratoplasty (PK), phacoemulsification, and intraocular lens (IOL) implantation, are complex ophthalmic surgeries.
• Open-sky capsulorrhexis is a critical step in these procedures, but can be challenging to perform accurately.
• Anterior capsule staining is a potential adjunct to improve capsulorrhexis visibility and execution.

Purpose of the Study:

• To evaluate the efficacy and safety of using trypan blue 0.1% capsule staining for open-sky capsulorrhexis during triple procedures.
• To compare the rates of complete capsulorrhexis and associated complications between stained and unstained groups.

Main Methods:

• A comparative study involving two groups of patients undergoing triple procedures.
• Group 1 (31 eyes) had anterior lens capsule stained with trypan blue 0.1% for open-sky capsulorrhexis.
• Group 2 (19 eyes) underwent open-sky capsulorrhexis without capsule staining.

Main Results:

• Complete open-sky capsulorrhexis was achieved in 90.4% of eyes in the trypan blue group versus 52.7% in the control group.
• The rates of incomplete capsulorrhexis, posterior capsule tear, and transscleral fixation IOL implantation were significantly higher in the unstained group (p < 0.05).
• Adverse reactions to trypan blue were not observed during the follow-up period.

Conclusions:

• Trypan blue 0.1% staining facilitates easier and safer open-sky capsulorrhexis with appropriate dimensions during triple procedures.
• Staining positively impacts other surgical steps and significantly reduces the incidence of posterior capsule tears.
• This technique offers a beneficial adjunct for improving outcomes in complex cataract and corneal surgeries.