Case Reports

Reflux of trypan blue under the pupillary margin into the anterior chamber during its removal as a sign of zonular weakness

Case Report Details

First Author: D.Anwar IRAQ

Co Author(s):                        

Abstract Details

Purpose:

To report a new sign of zoular weakness during cataract surgery. To our knowledge, this is the first time this sign of zonular weakness is reported.

Setting:

North Eye Center

Report of Case:

Ten eyes underwent cataract surgery using phacoemulsification by one surgeon (DA). Mean age was 74 years. They all have visually significant cataracts. Preoperatively, during slit-lamp exam, zonular weakness was not noted. Intraoperoperatively, during removal of the trypan blue out of the anterior chamber, reflux of the trypan blue under the pupillary margin back into the anterior chamber was noted. When surgery continued, other well-known signs of zonular weakness were observed .All ten eyes underwent cataract surgery had zonular weakness. This was confirmed by observing other signs of zonular weakness during cataract surgery. Two of the eyes also needed capsular tension ring implantation to stabilize the lens capsular bag.

Conclusion/Take Home Message:

It seems that zonular weakness causing the lens to displace posteriorly causing more space between the lens and the iris which acts as a pocket and holds more trypan blue during anterior capsule staining. During removal of the trypan blue by anterior chamber washout, more trypan blue is refluxing into the anterior chamber from this pocket.This sign could warn the surgeons about the unnoticed zonular weakness during preop exam and this will make them to take the necessary precautions during surgery and change plan accordingly. Further studies are also necessary to show the excess trypan blue under the iris by appropriate imaging techniues.

Financial Disclosure:

None