title: Open-sky capsulorrhexis in triple procedure: with or without trypan blue?
abstract: OBJECTIVE
  To establish the beneficial effects of trypan blue 0.1% capsule staining in open-sky capsulorrhexis during triple procedure.
  
  
  METHODS
  Patients who underwent penetrating keratoplasty (PK) with phacoemulsification and intraocular lens (IOL) implantation were divided into two groups. Group 1 consisted of 31 eyes of 26 patients with a mean age 64.4 +/- 6.9 years and anterior lens capsule was stained with trypan blue 0.1% to perform open-sky capsulorrhexis. In Group 2, capsulorhexis was performed without staining of the anterior capsule in 19 eyes of 17 patients with a mean age 60.6 +/- 5.3 years. The rates of complete capsulorrhexis and intra- and postoperative capsule-related complications were compared between the groups.
  
  
  RESULTS
  The most common diagnosis before PK was corneal opacification in both groups. Open-sky capsulorrhexis was not completed in 3 eyes (9.6%) in Group 1 and in 9 eyes (47.3%) in Group 2. The rates of incomplete capsulorrhexis, posterior capsule tear, and transscleral fixation IOL implantation were higher in Group 2 (for each, p < 0.05). The diameters of capsulorrhexis were smaller than 4.5 mm in one eye in Group 1 and in two eyes in Group 2, and larger than 6.5 mm in two eyes in Group 1 and in three eyes in Group 2. Malposition of IOL, zonular dialysis, retinal detachment, and pupil capture were only observed in eyes in Group 2. In the follow-up period, there were no adverse reactions due to application of trypan blue in Group 1.
  
  
  CONCLUSIONS
  Trypan blue staining of the anterior capsule during triple procedure helps the surgeon perform open-sky capsulorrhexis more easily and safely and in proper dimensions, provides positive effects on the other steps of the surgery, and decreases the rate of posterior capsule tear formation.
authors.affiliation: Erciyes University Medical Faculty, Kayseri, Turkey. aozkiris@erciyes.edu.tr
authors.forename: A
authors.initials: A
authors.lastname: Ozkiriş
authors.forename: O
authors.initials: O
authors.lastname: Arslan
authors.forename: E
authors.initials: E
authors.lastname: Cicik
authors.forename: N
authors.initials: N
authors.lastname: Köylüoglu
authors.forename: C
authors.initials: C
authors.lastname: Evereklioglu
mesh_terms: D000328:Adult; D019923:Capsulorhexis / Q000379:methods*; D002386:Cataract / Q000473:pathology; D004396:Coloring Agents; D005260:Female; D049669:History, 16th Century; D006801:Humans; D007431:Intraoperative Complications; D015948:Keratoplasty, Penetrating; D007903:Lens Capsule, Crystalline / Q000033:anatomy & histology / Q000601:surgery; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D011183:Postoperative Complications; D011446:Prospective Studies; D012449:Safety; D013194:Staining and Labeling / Q000379:methods; D016896:Treatment Outcome; D014343:Trypan Blue; D014792:Visual Acuity
chemical_list: D004396:Coloring Agents; D014343:Trypan Blue