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Outcomes of paediatric cataract surgery with and without the use of trypan blue
Aminatu AbdulRahman1, Cova Bascaran2, John Buchan2
1Department of Paediatric Ophthalmology & Strabismus, National Eye Centre, Kaduna, Nigeria.
Insights
Trypan blue staining in pediatric cataract surgery likely improves outcomes, such as complete posterior capsulorhexis and optimal intraocular lens placement. Further research is needed to confirm these findings in children with primary cataracts.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Primary cataracts in children require surgical intervention.
- Ensuring successful surgical outcomes, including capsulorhexis and intraocular lens (IOL) placement, is crucial in pediatric cataract surgery.
Purpose of the Study:
- To evaluate the outcomes of pediatric cataract surgery with and without trypan blue staining of the posterior lens capsule.
- To compare the effectiveness of posterior continuous curvilinear capsulorhexis (PCCC) and posterior chamber intraocular lens (PCIOL) implantation with and without trypan blue staining.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) published between 1946 and 2021.
- Electronic search across six biomedical databases for studies comparing trypan blue staining versus no staining in children (0-16 years) with primary cataracts.
- Data extraction, risk of bias assessment, and synthesis by two independent reviewers.
Main Results:
- Two RCTs involving 42 participants (56 eyes) were included.
- Trypan blue staining resulted in complete posterior capsulorhexis and optimal IOL placement in over 90% of cases.
- Control groups (no staining) achieved these outcomes in 65%-80% of cases.
Conclusions:
- Trypan blue staining appears to improve outcomes in pediatric cataract surgery.
- More high-quality RCTs are necessary to solidify the evidence base for using trypan blue in this population.
Objective:
This systematic review was undertaken to answer the research question: "In children with primary cataracts, what are the outcomes (posterior continuous curvilinear capsulorhexis + posterior chamber intraocular lens implantation) of surgery when performed with and without trypan blue staining of the posterior lens capsule?"
Methods:
An electronic search in six biomedical databases was conducted to identify randomised controlled trials that compared trypan blue with no stain during surgery in children 0-16 years with primary cataracts. Titles and abstracts of studies published between 1946 and 2021 in English language were screened. Data extraction, risk of bias assessment and synthesis of findings were done by two independent reviewers, while conflicts were discussed and resolved with a third.
Results:
A total of 115 of 153 articles were screened after de-duplication. Of these, 113 were excluded while 2 randomised controlled trials involving 56 eyes of 42 participants were included in the review. The risk of bias was similar across all domains in both. Staining of the capsule led to complete posterior capsulorhexis and optimal placement of the implant in >90% of study eyes, while the control arms had 65%-80% for both outcomes.
Conclusion:
Use of trypan blue in paediatric cataract surgery probably leads to better outcomes, but more well-conducted randomised controlled trials on this important topic are needed.
