Capsule Staining Research Articles

In vitro capsule or biofilm formation of Streptococcus uberis and bacteriological cure of bovine mastitis.

The relationship between the in vitro detected virulence factors biofilm and capsule formation of Streptococcus (S.) uberis isolates of clinical mastitis in dairy cows and the bacteriological cure rate after antibiotic therapy was investigated in order to better understand the importance of these virulence factors for the bacteriological cure rate. A total of 111 clinical mastitis (CM) cases were collected, in which S. uberis was bacteriologically detected. All mastitis cases were treated in accordance with the approval conditions of the antibiotic udder tubes used. Individual cow information including age, number of lactations, current lactation mastitis and antimicrobial treatment received was recorded. The microtiter plate test was used to detect biofilm formation and Anthony capsule staining was used to detect capsular capacity. Statistical analyses were performed to characterize the correlation between in vitro virulence factors and bacteriological cure (BC) rate. 30.5% (n=29) of the S. uberis isolates of bacteriologically cured cases and 34.5% (n=10) of the isolates of bacteriologically non-cured mastitis cases were found to have the ability to produce capsules in vitro. 70.7% (n=58) of the S. uberis isolates from bacteriologically cured mastitis cases had the ability to produce biofilm in vitro, whereas 58.6% (n=17) of the isolates of non-cured mastitis cases showed ability in producing biofilm. No correlation was found between the in vitro ability of S. uberis to form capsules and biofilms and the BC rate after antibiotic treatment of bovine mastitis. The present work has shown that the investigated in vitro virulence factors are not associated with the BC after antibiotic therapy. Further studies on the role of S. uberis virulence factors are needed to complete the missing knowledge on the difficulties in curing S. uberis mastitis. This study is of great clinical relevance since it enhances the understanding of the occurrence of BC in S. uberis mastitis cases. The investigated virulence factors are often addressed as possible reasons for therapy failure, although respective scientific studies are missing.

Automated Capsular Decompression to Avoid Argentinian Flag Sign in Intumescent Cataract.

We describe an alternative automated technique that consists of simultaneous anterior capsule puncture and decompression of the capsular bag by using an insulin needle attached to the aspiration tubing of the phacoemulsification device to prevent the occurrence of the "Argentinian Flag sign" during capsulorhexis in intumescent cataract. Instituto de Olhos de Assis and Center of Specialties Hoftalmed, located in the state of São Paulo, Brazil. Prospective interventional study. Eighty-eight eyes of 88 patients with white or intumescent cataracts were included in this study. Routine clear cornea incision, capsule staining with trypan blue, intracameral anesthesia, and ophthalmic viscoelastic device were used before the procedure. A 26-gauge needle was connected to the phacoemulsification aspiration tubing using a double male Luer connector for irrigation, and aspiration was inserted into the anterior chamber through a new paracentesis incision with the bevel facing down. Immediately after insertion, automated aspiration of the liquefied cortex was performed to remove anterior intralenticular material and achieve capsular decompression. Compression of the nucleus with the needle tip was performed to remove any liquefied material trapped between the posterior surface of the nucleus and the posterior capsule. All surgeries were performed using the same phacoemulsification and parameters. The rate of complete continuous capsulorhexis was observed and noted. No complications were observed in any of the cases. A single-stage, continuous, and well-centered capsulorhexis was achieved in 100% of cases. We conclude that a simultaneous puncture and decompression of the capsular bag using an insulin needle attached to the aspiration tubing of the phacoemulsification machine effectively avoided the "Argentinian Flag sign" in intumescent cataract surgery.

Intraoperative trypan blue central landmark and its use in capsulotomy and capsulorhexis centration.

To compare 3 capsulotomy centration methods. Private clinic, Zlin, Czech Republic. Prospective, consecutive case series. 180 eyes undergoing cataract surgery had anterior capsule staining with microfiltered 0.4% trypan blue solution before selective laser capsulotomy. The first 60 eyes (Group 1) had mydriatic dilated pupil centered capsulotomies. The next 60 eyes (Group 2) were centered on the trypan blue central landmark (TCL). The final 60 capsulotomies (Group 3) were centered on the patient fixated coaxial Purkinje reflex (CPR). Measurements between key anatomical landmarks and the TCL, CPR capsulotomies, and implanted intraocular lens (IOL) center were made. The TCL, observed in >94% of eyes in the study, coincided with the CPR with a displacement of <0.1 ± 0.1 mm. Group 1 capsulotomies were noticeably decentered on the IOLs by 0.3 ± 0.2 mm. The Group 2 symmetrical IOL relationship was maintained with a decentration of 0.15 ± 0.1 mm. Group 3 had a similar decentration with the IOLs with 0.15 ± 0.1 mm. Verification with IOLMaster 700 data and CALLISTO Eye System showed that the CPR and the TCL were coincident with the measured visual axis. The clearly visible TCL served as an alternate landmark to the patient fixated CPR, and being on the anterior capsule was not sensitive to tilt. Further patient compliance was not required. Both were superior to dilated pupil centration, to achieve symmetric IOL coverage. This has application for both capsulotomies and capsulorhexes.

Intraoperative corneal staining during cataract surgery

Intraoperative corneal staining with trypan blue dye is an uncommon complication of cataract surgery that occurs at the time of staining of the anterior capsule. Inadvertent corneal staining with Descemet’s membrane detachment (DMD) occurred in a 70-year-old male, while stromal edema following corneal staining occurred in an 80-year-old female while attempting to stain the anterior capsule. DMD was managed with air tamponade, and stromal edema was conservatively managed. One must thus be aware of corneal staining with trypan blue during cataract surgery. This complication can be avoided by using sharp-tipped instruments, proper wound construction, and proper depth perception, which can be done by adjusting the microscope.

Comparative histomorphologic study of basement membrane side staining and additional epithelial side staining of the anterior lens capsule with Trypan Blue.

To compare the histomorphologic changes on the anterior lens capsule by both epithelial and basement membrane side staining to those of only basement membrane side staining of the anterior lens capsule with Trypan Blue (TB). A cross-sectional study was done on 72 samples from patients who underwent cataract surgery between April 2021 and September 2022. After capsulorhexis of the TB-stained capsule, it was made into two halves externally and one half labeled as controls (sample A). The other half was immediately stained further with TB on the epithelial side and was taken as cases (sample B). Samples were analyzed for lens epithelial cells and basement membrane changes. The loss of intactness of lens epithelial cells, partial or complete detachment of lens epithelial cells, degeneration of lens epithelial cells, and basement edema were significantly higher in cases compared to controls, whereas intactness of the basement membrane did not show any statistical significance between the two groups. There was a statistically significant decrease in cell density in cases compared to controls. Staining the epithelial side of the capsular bag with TB is more detrimental to lens epithelial cells and paves the way for a further study of staining the capsular bag before intra-ocular lens implantation to reduce the incidence of posterior capsule opacification.

Block of the Pericapsular Nerve Group of the Hip with and without Ultrasound Guidance: Comparative Cadaveric Study.

Objective To evaluate the technical reproducibility of a block of the pericapsular nerve group (PENG) of the hip aided or not by ultrasound in cadavers. Materials and Methods The present is a randomized, descriptive, and comparative anatomical study on 40 hips from 2 cadaver groups. We compared the PENG block technique with the method with no ultrasound guidance. After injecting a methylene blue dye, we verified the dispersion and topographical staining of the anterior hip capsule through dissection. In addition, we evaluated the injection orifice in both techniques. Results In the comparative analysis of the techniques, there were no puncture failures, damage to noble structures in the orifice path, or differences in the results. Only 1 hip from each group (5%) presented inadequate dye dispersion within the anterior capsule, and in 95% of the cases submitted to either technique, there was adequate dye dispersion at the target region. Conclusion Hip PENG block with no ultrasound guidance is feasible, safe, effective, and highly reliable compared to its conventional counterpart. The present is a pioneer study that can help patients with hip pain from various causes in need of relief.

When it is all blue during phacoemulsification!

Trypan blue dye–assisted capsulorrhexis has been found to be very useful and effective during cataract surgery. Although this technique is safe and simplifies capsulorrhexis, especially in mature white cataracts, inadvertent staining of posterior capsule and vitreous has been reported in patients with history of trauma, ocular surgery, and pseudoexfoliation. Compromised zonular integrity has been observed to be the most probable underlying etiology for such a complication. Here, we report a case of vitreous staining without any clinical evidence of zonular compromise preoperatively.

The Long Noncoding RNA H19 Promotes Fibrotic Processes in Lens Epithelial Cells.

The purpose of this study was to investigate the role of lncRNA H19 in epithelial-mesenchymal transition (EMT) and its molecular mechanism in fibrotic cataracts. TGF-β2-induced EMT was induced in human lens epithelial cell line (HLECs) and rat lens explants to mimic posterior capsular opacification (PCO) in vitro and in vivo. Anterior subcapsular cataract (ASC) was induced in C57BL/6J mice. The long noncoding RNA (lncRNA) H19 (H19) expression was detected by RT-qPCR. Whole-mount staining of lens anterior capsule was used to detect α-SMA and vimentin. Lentiviruses carrying shRNA or H19 vector were transfected in HLECs to knockdown or overexpress H19. Cell migration and proliferation were characterized by EdU, Transwell, and scratch assay. EMT level was detected by Western blotting and immunofluorescence. The rAAV2 carrying mouse H19 shRNA was injected into ASC model mouse anterior chambers as a gene therapy to determine its therapeutic potential. PCO and ASC models were built successfully. We found H19 upregulation in PCO and ASC models in vivo and in vitro. Overexpression of H19 by lentivirus transfection increased cell migration, proliferation, and EMT. In addition, H19 knockdown by lentivirus suppressed cell migration, proliferation, and EMT levels in HLECs. Moreover, transfection of rAAV2 H19 shRNA alleviated fibrotic area in ASC mouse lens anterior capsules. Excessive H19 participates in lens fibrosis. Overexpression of H19 increases, whereas knockdown of H19 ameliorates HLECs migration, proliferation, and EMT. These results demonstrate H19 might be a potential target for fibrotic cataracts.

Clinical Observation of Non-Staining Circular Capsulorhexis for Hypermature Cataract

Objective: To explore the circular capsulorhexis method and its clinical effect in phacoemulsification of hypermature cataract without staining. Methods: In this prospective randomized case-control study, 22 patients (22 eyes) with hypermature cataract were randomly divided into a staining agent group (10 cases, 10 eyes) and a non-staining agent group (12 cases, 12 eyes). Both groups underwent phacoemulsification with foldable intraocular lens implantation under topical anesthesia. In the staining agent group, 0.5% indocyanine green was used to stain the anterior lens capsule to assist in circular capsulorhexis; in the non-staining agent group, after puncturing the anterior lens capsule and aspirating the liquefied cortical material, the capsular bag was filled with viscoelastic agent to increase the contrast prior to circular capsulorhexis. The operability of the anterior capsule without staining in capsulorhexis was observed, and the effect of capsulorhexis, diameter of capsulorhexis opening, and operative time were compared and analyzed between the two groups. Results: Both groups successfully underwent circular capsulorhexis, with a success rate of 100%. The diameters of capsulorhexis opening in the staining agent group and non-staining agent group were 5.68 ± 0.15 mm and 5.54 ± 0.16 mm, respectively, without any statistical difference between the groups (P &gt; 0.05); the operative time of the staining agent group (40.40 ± 5.42 s) was shorter than that of the non-staining agent group (50.92 ± 3.97 s), and the difference was statistically significant (P &lt; 0.001). In both groups, phacoemulsification was successful, and intraocular lens were implanted into the capsular bags; their visual acuity showed significant improvement during the 1-month follow-up period after surgery, without any surgical complications. Conclusion: In hypermature cataract, injecting viscoelastic agent into the capsular bag for volume replacement, given a lack of capsule staining agent, can increase the contrast for capsulorhexis and reduce the risk of large capsular bag collapse on the zonular ligament. Thus, it is considered safe and effective. Circular capsulorhexis is conducive to a smooth phacoemulsification procedure.

Halotolerant bacterial biofilms for desalination and water treatment: a pilot study.

Salinity has a significant impact on the water quality and crop yield. Physical desalination techniques were once thought to be expensive and time-consuming. Among biological techniques, halotolerant bacteria were thought to be the fastest and most effective way to reduce the salt content in brackish saltwater water. In the current study, halotolerant bacterial biofilms were used to desalinate saline water on abiotic substrates (such as sand, pebbles, glass beads, and plastic beads), and studied subsequently for the effects on Zea mays germination. Briefly, salt samples (SLT7 and SLT8) from the Khewra site in Punjab, Pakistan, as well as seawater and sea sand samples (USW1, USW3, USW6, DSW1, DSW4, SS1, and SS3) from Karachi, Sindh, Pakistan's Arabian Sea, were collected. Halotolerant bacteria were isolated and characterized. Crystal violet ring assays and capsule staining were used to estimate extracellular polymeric substance (EPS) and biofilm development, respectively. All halotolerant bacterial strains were spore formers and produced EPS and formed biofilms well. 16S rRNA gene sequencing of the best halotolerant bacteria, USW6, showed the closest (100%) similarity to Bacillus aerius strain G-07 (a novel species) (accession number ON202984). A pilot-scale experiment for desalinating the artificial water (supplemented with 1M NaCl) using biofilm adhered abiotic beads showed declined level of NaCl from 1M to 0.00003M after 15days in treated water. Also, Zea mays germination was observed in the plants using treated water compared to no growth in the non-treated saline water. Estimations of chlorophyll, total soluble sugar, and protein revealed that plants cultivated using elute collected from a desalinated pilot scale setup contained less chlorophyll (i.e., 5.994 and 116.76). Likewise, plants grown with elute had a total soluble protein and sugar content of 1.45mg/ml and 1.3mg/ml, respectively. Overall, in treated water plants, a minor drop in chlorophyll content, a slight increase in total soluble sugar content, and a slight increase in protein content were noted. The study concluded that biofilm-treated desalt water has the potential to significantly reduce the effects of droughts, soil salinization, and economic and environmental issues associated with agricultural drainage. The results specified the application of halotolerant bacteria biofilms (Bacillus aerius, a novel species, USW6) for water desalination to overcome the problem of water scarcity caused by global warming and the increased salinity.

Selective laser capsulotomy complications: Management and prevention.

To report how to manage and prevent the incomplete laser cut and following uncut tags of anterior capsular lens, performed using the selective laser capsulotomy. We describe three possible approaches: peeling the anterior capsulotomy disc with forceps, breaking the tags using the cystotomy needle tip, or cutting them using a 23-G vitrectomy scissors. Using the 23-G vitrectomy scissors resulted in no complication. Peeling the anterior capsulotomy using the forceps instead caused zonular stress with subsequent risks of zonular dialysis, whereas using the cystotomy needle tip resulted in irregular capsulotomy rim and weakness all along the capsulotomy edge where micro tears caused a tear during the rest of cataract surgery. Incomplete laser cut and subsequent discontinuous capsulotomy results in the presence of multiple tags which create strong adherence between the central capsulotomy disc and the peripheral capsule. Key steps of the procedure to prevent an incomplete laser cut, which are the anterior lens capsule staining and laser beam focusing, and how to correctly manage them, which may shorten the learning curve and enhance the outcomes.

Ex vivo evaluation of anterior lens capsule staining in horses with three concentrations of gentian violet for surgical training

Resumo O objetivo deste estudo foi avaliar e comparar a eficácia de três concentrações de violeta genciana (0,5%, 0,1% e 0,05%) na coloração da cápsula anterior da lente em equinos. Trinta e seis olhos de equinos post-morten foram utilizados. De acordo com a concentração de violeta genciana utilizada, os olhos foram subdivididos em três grupos compostos por 12 olhos cada. A avaliação da eficácia em coloração da cápsula anterior da lente com diferentes concentrações de violeta de genciana foi realizada por meio de um sistema empírico de avaliação da coloração adequada ou inadequada de retalhos capsulares. Com base na avaliação dos examinadores, as concentrações de 0,1% e 0,05% de violeta de genciana permitiram a visualização adequada da cápsula anterior para o treinamento da capsulotomia curvilínea contínua enquanto a concentração de 0,5% produziu uma coloração capsular forte e inadequada. O modelo desenvolvido com violeta genciana, nas concentrações de 0,1% e 0,05%, permitiu a visualização nítida do retalho capsular, o que o torna viável como modelo para treinamento da etapa de capsulotomia curvilínea contínua em cirurgia de catarata em equinos.

Corneal Endothelial Cell Changes after Phacoemulsification with and without Trypan Blue Anterior Capsule Staining

Corneal Endothelial Cell Changes after Phacoemulsification with and without Trypan Blue Anterior Capsule Staining

Усовершенствованная технология факоэмульсификации набухающей катаракты с фемтолазерным сопровождением

Purpose. To optimize the technology of femtolaser-assisted intumescent cataract phacoemulsification. Material and methods. Group I included 29 patients (30 eyes) with intumescent mature cataract, who underwent femtolaser-assisted phacoemulsification using a new, advanced technology. Group II included 20 patients (20 eyes), in whom the femtolaser stage was performed using standard technology. In all preoperative parameters, patients in groups I and II were almost identical. The advanced femtocapsulorexis technology included: preoperative assessment of intralenticular pressure, staining of the anterior capsule of the swelling lens with trypan blue, introduction of a high molecular weight viscoelastic into the anterior chamber to balance intraocular and intralenticular pressure, increasing the laser energy up to 10 mJ when performing anterior capsulorhexis. Results. In group I, in 2 eyes there was a non-penetration of the anterior capsule, in one eye in the 30° sector, in the second – in the 45° sector. The leakage of the lens material into the anterior chamber and the floating anterior capsule were not observed in patients of group I. In group II, non-penetration of the anterior capsule was observed in 6 eyes, in the 140–150° sector – in 2 eyes, in the 90° sector – in 3 eyes, in the 180° sector – in 1 eye. A floating anterior capsule was observed in 5 cases. The leakage of the lens material into the anterior chamber was observed in 9 eyes. Conclusion. The advanced technology of femtolaser-assisted intumescent cataract phacoemulsification excludes the leakage of lens material into the anterior chamber and allows performing the anterior capsulorhexis of a given size and shape. Keywords: intumescent cataract, phacoemulsification, femtolaser-assisted, anterior apsulorhexis.

Perioperative nuances of cataract surgery in ocular surface disorders.

Ocular surface disorders (OSDs) constitute a varied spectrum of conditions that could be associated with dryness, compromised limbal status, varying grades of forniceal obliteration, corneal scars, and a possible underlying immune etiology. These associations adversely impact surgical outcomes in the eye. One of the treatable causes of decreased vision in these eyes is cataracts which could be secondary to the disease, its treatment, or age-related. The compromised ocular surface status can interfere with decision-making regarding the technique of cataract surgery, preoperative biometry for intraocular lens (IOL) power calculation, and intraoperative visibility, increasing the possibility of complications and compromising the final visual outcome. The postoperative course can be affected by complications, including melt and infection. Stabilization of the ocular surface by medical or surgical means, and appropriate management of underlying immune etiology, if any, helps improve and maintain a healthy ocular surface, optimizing cataract outcomes. With the help of pre, intra, and postoperative tools and means, such as punctal occlusion, ocular surface reconstruction, systemic immunosuppression, illuminators, capsule staining dyes, optical iridectomy, prosthetic replacement of the ocular surface ecosystem (PROSE) lenses, and others, the visual outcome post-cataract surgery in these eyes can be maximized. This article highlights the nuances of performing cataract surgery in various OSDs and the need to have a comprehensive stepwise approach is emphasized.

Outcomes of paediatric cataract surgery with and without the use of trypan blue.

This systematic review was undertaken to answer the research question: "In children with primary cataracts, what are the outcomes (posterior continuous curvilinear capsulorhexis + posterior chamber intraocular lens implantation) of surgery when performed with and without trypan blue staining of the posterior lens capsule?" An electronic search in six biomedical databases was conducted to identify randomised controlled trials that compared trypan blue with no stain during surgery in children 0-16 years with primary cataracts. Titles and abstracts of studies published between 1946 and 2021 in English language were screened. Data extraction, risk of bias assessment and synthesis of findings were done by two independent reviewers, while conflicts were discussed and resolved with a third. A total of 115 of 153 articles were screened after de-duplication. Of these, 113 were excluded while 2 randomised controlled trials involving 56 eyes of 42 participants were included in the review. The risk of bias was similar across all domains in both. Staining of the capsule led to complete posterior capsulorhexis and optimal placement of the implant in >90% of study eyes, while the control arms had 65%-80% for both outcomes. Use of trypan blue in paediatric cataract surgery probably leads to better outcomes, but more well-conducted randomised controlled trials on this important topic are needed.

Prevalence of Carbapenem-Resistant Hypervirulent Klebsiella pneumoniae and Hypervirulent Carbapenem-Resistant Klebsiella pneumoniae in China Determined via Mouse Lethality Tests.

ObjectiveTo investigate the epidemiology of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-HvKP) and hypervirulent carbapenem-resistant Klebsiella pneumoniae (Hv-CRKP).MethodsTotally 436 K. pneumoniae strains were collected from 7 hospitals in mainland China between 2017.01 and 2018.02. Sequence types, serotypes, antimicrobial-resistance and virulence genes were analyzed. Additionally, string test, capsule stain, Periodic Acid Schiff stain, fitness analysis, quantitative real-time PCR and mouse lethality test were also performed. Molecular combinations were used to screen putative bla KPC(+)-HvKP and Hv-bla KPC(+)-KP, followed by the confirmation of mouse lethality test.ResultsDiverse detection rates were found for the virulence genes, ranging from c-rmpA (0.0%) to entB (100.0%). According to the molecular criteria, 127, 186, 9 and 26 strains were putatively denoted as HvKP, bla KPC(+)-KP, bla KPC(+)-HvKP and Hv-bla KPC(+)-KP. Mouse lethality test confirmed 2 bla KPC(+)-HvKP strains (JS184 and TZ20) and no Hv-bla KPC(+)-KP. JS184 showed K2 serotype, thin capsule, positive exopolysaccharid and string test. TZ20 presented K20 serotype, thin capsule, negative exopolysaccharide and string test. Compared with the positive control NTUH-K2044, equal galF expression and growth curves were confirmed for JS184 and TZ20.ConclusionsMolecular determination of CR-HvKP and Hv-CRKP brings remarkable bias compared with mouse lethality test. The exact prevalence of CR-HvKP is less than 1.0%, which of Hv-CRKP is much lower.

Evaluation of the safety of anterior capsule staining with trypan blue under air: a retrospective analysis.

To evaluate the safety of using 0.03% trypan blue under air for anterior capsule staining in cataract surgery. The current study involved a retrospective analysis of the medical records of 86 patients with vitreous hemorrhage, who underwent pars plana vitrectomy and cataract surgery. The patients were classified into two groups. The trypan blue group (n=45) comprised patients who underwent anterior capsule staining with 0.03% trypan blue under an air bubble. The control group (n=41) comprised of patients who underwent intracameral illuminator-assisted capsulorhexis. The status of endothelial cell density (ECD) in both the groups was analyzed. The trypan blue group displayed significant decline in ECD at 1mo (7.91% loss, P<0.001) and 3mo (9.65% loss, P<0.001) after the surgery, whereas no significant changes were observed in the control group. Moreover, the number of patients who did not display a postoperative decline in ECD was significantly higher in the control group (43.9%; 18 patients) than in the trypan blue group (17.1%; 7 patients, P=0.004). Anterior capsule staining with trypan blue under the air bubble would not be as safe as the intracameral illuminator. The ECD loss might be attributed to the air bubble rather than to the deleterious effects of 0.03% trypan blue. Further studies are required to clarify this.

Femtolaser-assisted phacoemulsification of intumescent cataract

To optimize the technique of intumescent cataract phacoemulsification by involving the use of femtosecond lasers. Group 1 included 29 patients (30 eyes) with mature intumescent cataract, who underwent femtolaser-assisted phacoemulsification using a new, optimized technique. Group 2 included 20 patients (20 eyes), in whom the femtolaser stage was performed using the standard technique. Patients of groups 1 and 2 were almost identical in all preoperative parameters. The optimized femto-capsulorhexis technique included: preoperative assessment of intralenticular pressure, staining of the anterior capsule of the swelling lens with trypan blue, introduction of a viscoelastic with high molecular weight into the anterior chamber to balance intraocular and intralenticular pressures, increasing the laser energy when performing anterior capsulorhexis up to 10 mJ. In group 1, there was a non-penetration of the anterior capsule in 2 eyes, in one of them in the 30° sector, in the second - in the 45° sector. Leakage of lens material into the anterior chamber and the floating anterior capsule were not observed in patients of group 1. In group 2, non-penetration of the anterior capsule was observed in 6 eyes, in the 45-60° sector - in 2 eyes, in the 90° sector - in 3 eyes, in the 180° sector - in 1 eye. Floating anterior capsule was observed in 5 cases. Leakage of lens material into the anterior chamber was observed in 9 eyes. The optimized technique of femtolaser-assisted intumescent cataract phacoemulsification eliminates leakage of lens material into the anterior chamber and allows performing anterior capsulorhexis of given size and shape.

Ex-Vivo Method to Quantifiably Evaluate the Staining Effectiveness of Anterior Lens Capsule Dyes.

PurposeHigh frequency of cataracts and the requirements of new European Union regulations for medical devices require the availability of preclinical models to adequately evaluate anterior lens capsule dyes before their use in patients. Herein, we describe an ex vivo method to quantifiably evaluate the macroscopic and microscopic staining effectiveness of anterior lens capsule dyes using porcine eyes.MethodsCommercially available trypan blue–based products or physiological saline solution (negative control) was injected into porcine eyes. Anterior pole and lens (after extraction) were macroscopically photographed, and the images were quantitatively analyzed. Lenses were histologically processed, and the staining intensity microscopically was semiquantified.ResultsMacroscopic evaluation of the anterior pole revealed bluish staining of the anterior capsule; however, this coloring cannot be macroscopically discerned after lens extraction. Quantitative image analyses showed significant (P < 0.01) staining of the lens capsule compared to the negative control, but not significant (P > 0.05) between the products tested. Quantitative analysis of dying on lens images could not be performed. Microscopic semiquantification of the capsule staining intensity allows us to appreciate differences between products.ConclusionsThe described method is a quick and useful tool for macroscopic evaluation by surgeons to choose an anterior capsule staining for use during everyday surgeries, and a more specific microscopic evaluation also allows us to determine the effectiveness and usefulness of these products.Translational RelevanceThis method satisfies preclinical effectiveness evaluations required by European Union regulations and complements the safety and toxicity evaluations that new products must guarantee before they enter the market and are used in clinical practice.