Pearls for Using Trypan Blue

Neil J. Friedman, M.D.

About Author

Visualization is critical when performing cataract surgery. This is particularly true for achieving and maintaining a clear view of the anterior capsule. During most routine cases with a bright red reflex, there is little or no difficulty seeing the anterior capsule when performing the capsulorhexis and then later during the procedure observing the edge of the capsulorhexis. However, a variety of situations may interfere with the surgeon's ability to clearly see the capsule.

Trypan blue 0.06% ophthalmic solution (VisionBlue) stains the anterior lens capsule making it clearly identifiable throughout surgery, and is an invaluable tool. The dye is injected onto and spread over the anterior lens capsule under an air bubble. Rather than using a separate syringe to inject the air bubble, it is more efficient to draw air through a filter into the preloaded VisionBlue syringe and then inject the air bubble followed by the dye all in one maneuver. The air bubble is then replaced with viscoelastic and the eye is entered with a keratome.

The primary indication for using this capsular dye is when the red reflex is poor or absent, which is typically due to a mature white cataract. In such instances, the readily visible blue stained capsule facilitates creating a complete capsulorhexis. Trypan blue is also very useful in cases of weak zonules. I routinely use the dye in all patients with pseudoexfoliation syndrome so that I can easily visualize the capsulorhexis edge throughout the surgery and more readily detect capsular instability by observing any shift in position of the capsulorhexis edge. Similarly, I have recently found in cases of extensive asteroid hyalosis that it can be difficult to visualize the capsule once the lens nucleus has been removed, and trypan blue can certainly improve visualize in this circumstance as well.

Trypan blue is safe, effective, and easy to use. For surgeons who struggle with visualization in the aforementioned types of cases, I recommend staining the capsule.