title: Inadvertent trypan blue posterior capsule staining during cataract surgery.
abstract: OBJECTIVE
  To report 5 cases of inadvertent posterior capsule staining with trypan blue during phacoemulsification.
  
  
  METHODS
  Retrospective, observational case series.
  
  
  METHODS
  Five cases of posterior capsule staining with trypan blue were identified from cataract surgeries performed at an academic institution. All 5 eyes underwent phacoemulsification with use of iris retractors. The surgical videos from each case were reviewed to better understand the mechanisms and risk factors for posterior capsule staining with trypan blue and techniques to avoid this complication.
  
  
  RESULTS
  No eyes had clinical evidence of zonular pathology during their preoperative examination. Only 1 patient reported a possible childhood history of trauma to both eyes. One eye had uveitis, requiring posterior synechialysis. All 5 cases involved the use of iris retractors. No other intraoperative complications occurred, and the intraocular lens was successfully placed in the capsular bag in all cases. All eyes had resolution of posterior capsule staining by postoperative day 8.
  
  
  CONCLUSIONS
  Inadvertent posterior capsule staining with trypan blue can occur in eyes that appear structurally normal. The use of iris retractors may facilitate posterior capsule staining by allowing the posterior flow of trypan blue under the iris and through the zonules to the posterior capsule. Surgeons should consider techniques to minimize the risk of posterior capsule staining, particularly in cases involving the use of iris retractors.
authors.affiliation: The Wilmer Eye Institute/The Johns Hopkins Bayview Medical Center, Baltimore, Maryland 21224, USA.
authors.forename: Bryn M
authors.initials: BM
authors.lastname: Burkholder
authors.forename: Divya
authors.initials: D
authors.lastname: Srikumaran
authors.forename: Afshan
authors.initials: A
authors.lastname: Nanji
authors.forename: Bryan
authors.initials: B
authors.lastname: Lee
authors.forename: Robert S
authors.initials: RS
authors.lastname: Weinberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004396:Coloring Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D018918:Phacoemulsification; D057852:Posterior Capsule of the Lens / Q000187:drug effects* / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D013194:Staining and Labeling; D014343:Trypan Blue / Q000009:adverse effects*
chemical_list: D004396:Coloring Agents; D014343:Trypan Blue