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.
Optiblue 0.06% ophthalmic solution 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.
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 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.
Optiblu is safe, effective, and easy to use. For surgeons who struggle with visualization in the aforementioned types of cases, I recommend staining the capsule. Its clinical use is listed below:
During Cataract Surgery
- It offers greatly enhanced visualization of the anterior capsule in eyes with mature cataract or narrow pupil.
- It provides a persistent and clear outline of the peripheral rim of the capsulorhexis by contrast between the stained rim and the adjacent lens mass.
- It reduces the risk of capsulorhexis-related complications by better visualization of radial capsule tears.
- It provides visualization of the "lost" edge of the capsulorhexis.
During Vitreoretinal Surgery:
- It provides appropriate staining of the ILM with excellent visualization.
- It provides a clear outline of the ILM with visualization of the leading egde to facilitate complete rhexis removal of the ILM.
- It provides appropriate staining of the ERM with excellent visualization of transparent epi-retinal membranes.