Effect of Intracapsular Trypan Blue on Refractive Predictability of Cataract Surgery
Purpose
To determine the effect of intracapsular trypan blue on the spread or variability of refractive outcomes after cataract surgery with a variety of implant types including accomodating, toric, and 3 piece lenses.
Methods
The study arm is prospective and non-masked involving 80 consecutive cataract surgeries by a single surgeon. Patients with advanced AMD, diabetic retinopathy, keratoconus and margin pellucid degeneration we excluded. All lens types used were included (toric, 3 piece silicone, and accomodating)
The intervention was injection of trypan blue for 1 minute into the non-viscoelastic filled capsular bag during the cataract surgery. This was done immediately after I/A.
The historical controls are the immediately preceeding 200 cases by the same surgeon.
No femtosecond laser or intra-operative abberometry was used during the sugery.
Outcomes measured: Refraction at 2-3 weeks post op compared to intended refraction.
Refractions were all done by standardized protocol.
Results
In the study group 57 of 80 eyes (72.5%) were +/- .25D of intended target vs 107 of 200 control eyes (53.5%).
In the study group 75 of 80 eyes (94%) were +/- .50D of intended target vs 146 of 200 control eyes (73%).
No eyes (0%) in the study group were > +/- .75 D of intended target vs 13% of the control eyes.
Conclusion
Trypan blue contact with the inside of the capsular bag for 1 minute during cataract surgery can reduce the variability of refractive outcome after surgery.
Trypan blue has been shown to be non-toxic to structures in the eye with the exception of lens epithelial cells. Diminishing the viability of remant lens epithelial cells may reduce the variability of individual responces to surgey in a way that improves refractive predicabilty across a variety of IOL platforms.