Non-infectious endophthalmitis associated with trypan blue use in cataract surgery

The visualization of the anterior lens capsule is greatly enhanced by trypan blue staining facilitating the creation of a continuous curvilinear capsulorhexis. Trypan blue has been deemed safe in this setting.

We report the findings and management of a retrospective interventional case series comprising three eyes that developed non-infectious endophthalmitis following routine trypan blue staining of the anterior lens capsule with the same batch of Vission (0.6 mg/ml) during uncomplicated small incision phacoemulsification of 17 consecutive eyes.

On post-op day 1, 18% had an increased cellular response in the anterior chamber and anterior vitreous precluding fundus visualization, 12% had a hypopyon. Initial visual acuity (VA) ranged from hand motions to light perception. Eyes were initially managed with topical and oral steroids. Two eyes underwent vitrectomy. Vitreous cultures were all negative. One eye had a repeat vitrectomy to remove an epiretinal membrane. Final VA achieved was 20/80, 20/20 and 20/20.

Trypan blue may be associated with severe intraocular inflammation.