ABSTRACT
Various non-toxic ophthalmic dyes have been extensively used as diagnostic agents for the detection and management of different ocular disorders. Table 12.1 summarizes the use of various dyes in ophthalmology. Dyes such as fluorescein sodium, indocyanine green (ICG), have a long history of safety in humans.1 There have been an increasing number of reports of enhanced visualization by staining intraocular tissues during cataract surgery and vitreoretinal surgery.2-19 Staining of the ocular tissue by using the ophthalmic dyes makes visual differentiation and manipulation of tissues easier. Enhanced viewing of the ocular tissues can promote a surgeon’s ability to evaluate clinical structural relationships and may help attain surgical objectives with fewer complications.2-19
Small incision cataract surgery using phacoemulsification has currently evolved into one of the most successful surgical techniques in ophthalmology and the visual sciences. Many modifications such as continuous curvilinear capsulorhexis (CCC),20,21 hydrodissection,22-25 hydrodelineation,26 and various maneuvers for nuclear emulsification and cortical clean-up have been added to it, increasing its safety and efficacy. Posterior capsulorhexis,
Segment Structure stained Use Dye Anterior segment
a technically challenging procedure, has also been recommended for delaying opacification of posterior capsule in pediatric cataracts and for managing the posterior capsule tears by several surgeons.27-31
We have extensively studied the use of non-toxic ophthalmic dyes (fluorescein sodium, ICG and trypan blue) to enhance visualization of various intraocular tissues while performing various critical steps of modern phacoemulsification procedure7-9,12-14 (pandey SK, Werner L, Escobar-Gomez M, Apple DJ. Anterior capsule staining in advanced cataracts: A laboratory study using postmortem human eyes; presented at the joint meeting of American Academy of Ophthalmology, Orlando, Florida, October 1999; Pandey SK, Werner L, Apple DJ, et al. Dye-enhanced cataract surgery in human eyes obtained postmortem: A laboratory study to learn critical steps of phacoemulsification: XVIIth Congress of the European Society of Cataract and Refractive Surgery, second prize: “Scientific Category,” Vienna, Austria, September 1999). In this chapter we will address the use of non-toxic ophthalmic dyes to successfully stain the intra-ocular tissues during various steps of modern phacoemulsification procedure. For the convenience of readers, we have divided this chapter in 4 sections, adressing their use in adult and pediatric cataract surgery. To provide a brief detail to our readers, in Section 1, we will discuss the use of ophthalmic dyes to stain the anterior capsule while performing CCC in advanced/white cataracts. In Section 2, we will focus on the use of ophthalmic dyes to help enhance visualization to learn the critical steps of phacoemulsification surgery,
which include: CCC, hydrodissection/hydrodelineation, nuclear emulsification, and cortical clean-up. In Section 3, we will address the use of ophthalmic dyes for posterior capsule staining to learn and perform technically challenging procedure of posterior capsulorhexis. Finally, in Section 4, we will focus on the use of ophthalmic dyes for pediatric cataract surgery.
