title: Permanent blue discoloration of a hydrogel intraocular lens by intraoperative trypan blue.
abstract: A 79-year-old white man had cataract surgery in the right eye with implantation of an Acqua intraocular lens (IOL) (Mediphacos). Trypan blue 0.1% was used during surgery to stain the anterior capsule and enhance the contrast during capsulorhexis. Seven days after surgery, the patient presented with "dark and double" vision (monocular diplopia). The IOL was decentered superiorly and appeared dark blue. The lens was explanted 2 months after surgery and sent for gross and microscopic analyses in a dry state and after hydration. The same analyses were performed on 2 unused lenses of the same design that had been immersed in diluted trypan blue solutions (0.01% and 0.001%). On the explanted lens, the dark blue staining was denser in the optic, especially in its periphery. The blue discoloration could not be removed after 24 hours of lens immersion in a balanced salt solution at 37 degrees C. Permanent staining of the unused lenses was also obtained after immersion in the trypan blue solutions.
authors.affiliation: Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina 29425-5536, USA. werner.@musc.edu
authors.forename: Liliana
authors.initials: L
authors.lastname: Werner
authors.forename: David J
authors.initials: DJ
authors.lastname: Apple
authors.forename: Armando S
authors.initials: AS
authors.lastname: Crema
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Izak
authors.forename: Suresh K
authors.initials: SK
authors.lastname: Pandey
authors.forename: Rupal H
authors.initials: RH
authors.lastname: Trivedi
authors.forename: Liwei
authors.initials: L
authors.lastname: Ma
mesh_terms: D000368:Aged; D019923:Capsulorhexis; D004396:Coloring Agents / Q000009:adverse effects*; D020878:Device Removal; D004172:Diplopia / Q000209:etiology; D006801:Humans; D020100:Hydrogels; D007431:Intraoperative Complications; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D008297:Male; D018918:Phacoemulsification; D011475:Prosthesis Failure; D013194:Staining and Labeling; D014343:Trypan Blue / Q000009:adverse effects*
chemical_list: D004396:Coloring Agents; D020100:Hydrogels; D014343:Trypan Blue