Posters

Discoloration of intraocular lenses by commercially available dyes for anterior and posterior segment intraocular surgery: a meta-analysis of literature, clinical observations and laboratory results

Poster Details

First Author: H. Gerding SWITZERLAND

Co Author(s):                        

Abstract Details

Purpose:

The use of intravital dyes for the staining of intraocular structures has become a gold standard in cataract surgery cases with poor retroillumination and in poster segement interventions when peeling of the internal limiting membrane (ILM) is desired. So far no systematic surveys are available on the risk of intraocular lens discoloration by commercially available dye preparations. This study was performed to analyze the incidence, intensity, distribution and longevity of intraocular lens (IOL) discoloration after clinical and experimental application by available dyes used for chromovitrectomy.

Setting:

This project included: 1. a meta-analysis of MEDLINE literature, 2. the analysis of institutionally documented clinical cases with IOL discoloration after intraocular surgery, and 3. performance of own laboratory tests on staining of IOL´s after exposure to commercially available intraocular dyes.

Methods:

A MEDLINE search was performed to identify relevant publications. Institutional files (last 11 years) were queried for IOL discoloration. In laboratory tests hydrophilic acrylic-, hydrophobic acrylic-, silicone-, and PMMA-IOL´s were exposed to Vision Blue®, Brilliant Peel®, Brilliant Peel Dual Dye®, ILM Blue®, Membrane Blue Dual®, Ala Purple®, and Tripledyne®. IOLs were incubated to undiluted dyes and 1:40 dilutions, representing typical vitrectomy exposure. Incubation time was 10 seconds, 1, 10, 60 minutes, or 12 hours. Discoloration was quantified by transillumination photometry. Disappearance of discoloration was analyzed in wash-out experiments and dye distribution was examined in microscopic sections of lenses.

Results:

Meta-analysis: 10 relevant publications (4 clinical, 9 with lab-test) were identified. Clinical observations included irreversible staining of highly hydrophilic IOLs (trypan blue, discoloration of silicone-IOLs (methylene blue) and transient discoloration of hydrophilic lenses (acid violet-17). The latter occurred in 12 institutional eyes with hydrophilic IOL´s and disappeared within four weeks postoperatively. Laboratory tests: Undiluted dyes caused discoloration after 10 minutes of hydrophilic IOLs. Similar effects occurred after prolonged exposure to 1:40-diluted dyes. PMMA-, silicone-, or hydrophobic-IOLs did not present significant discoloration. Minor discoloration disappeared in was-out tests within days to several weeks. Intensive IOL staining persisted >3 months.

Conclusions:

The recent clinical observation of hydrophilic acrylic IOL staining indicates that there is a realistic risk of IOL discoloration when using commercially available dyes approved for ocular surgery. Our experimental results demonstrated that all available dyes may lead to significant and intensive staining of hydrophilic acrylic intraocular lenses. Direct contact of the IOL surface to undiluted dyes should be avoided and residual dye should always be carefully removed from the vitreous cavity during surgery.

Financial Disclosure:

NONE