Cataract surgery and the "Blue Miracle"

Abstract

Continuous circular capsulorhexis enabling safe phacoemulsification and implantation of the PC-IOL in the bag is extremely difficult to perform in the absence of red reflex. Staining of the anterior capsule with a vital dye (Vision blue(R); DORC, The Netherlands) allows easy capsulorhexis under such conditions. Because of missing or poor red reflex Vision blue(R) was applied to allow capsulorhexis in 26 eyes of 25 patients (aged 24 - 86 years). Sixteen patients had mature cataracts, two patients had dense vitreous opacities and 8 patients had pronounced anterior subcapsular opacifications. Continuos circular capsulorhexis was easy to perform in 22/26 eyes after staining the anterior capsule with Vision blue(R). Due to increased intracapsular pressure two eyes developed an uncontrolled tearing of the anterior capsule towards the periphery, and in two eyes capsulotomy had to be completed with high-frequency capsulotomy or scissors. Ten of sixteen eyes with mature cataracts had extremely hard nuclei requiring extended phacoemulsification time (more than 90 seconds calculated for 100 % power). There was no rupture of the posterior capsule nor vitreous loss. All PC-IOL's (23 x Acrysof(R); Alcon; 3 x 6.5 mm PMMA) were implanted into the capsular bag. Preoperatively 19/26 eyes had visual acuity of handmotions or less, postoperatively 18/26 eyes achieved 20/30 or better visual acuity. In the absence of red reflex staining of the anterior capsule with Vision blue(R) allows continuous circular capsulorhexis and implantation of the PC-IOL in the bag. An extremely hard nucleus requiring extended phacoemulsification time must be expected in elderly patients with mature cataracts.