Indocyanine green–dye staining of a filtering bleb during cataract surgery

Abstract

An 80-year-old woman with primary open-angle glaucoma had had trabeculectomy 2 years earlier.On presentation, slitlamp examination showed an almost mature intumescent cataract. A diffuse, elevated, avascular filtering bleb was observed preoperatively. For visualizing the anterior capsule, 0.3 mL of ICG 0.5% dye was used intraoperatively. During the capsulorhexis, gradual intense staining of the filtering bleb was observed as the ICG dye passed into the bleb. Over the 2 weeks following the uneventful cataract surgery, the ICG dye stain faded away. To our knowledge, this is the first video-documented report of ICG dye staining of a filtering bleb. This case indicates that dye-enhanced phacoemulsification might be helpful in indirectly evaluating the bleb function as well as facilitating the capsulotomy. Financial Disclosure: Neither author has a financial or proprietary interest in any material or method mentioned. JCRS Online Case Reports 2014; 2:78-79 Q 2014 ASCRS and ESCRS Online VideoPerforming capsulorhexis as an anterior capsulotomy is an important step in cataract surgery. 1 Thus, various dyes are used to enhance the visibility of the anterior capsule in a white cataract. 1,2 Among them, indocyanine green (ICG) and trypan blue are used widely because of their safety profile. 2 However, no case report has been published on ICG dye staining of a filtering bleb during cataract surgery and its effect. We report a video-documented case of ICG dye staining of a functional filtering bleb and its effect on a patient who had had a trabeculectomy. CASE REPORTAn 80-year-old woman presented at our clinic with decreased vision in her right eye for several months. She had had a trabeculectomy with mitomycin-C in both eyes 2 years earlier to treat primary open-angle glaucoma. The examination showed uncorrected distance visual acuity of hand motion and intraocular pressure (IOP) of 7 mm Hg in the right eye. The slitlamp examination showed an almost totally white lens opacity with intumescence (Figure 1, a). A diffuse, elevated, avascular filtering bleb was observed at the superior conjunctiva in the right eye (Figure 1, b). There was no evidence of phacodonesis, iris atrophy, or previous ocular inflammation.Phacoemulsification was performed via a temporal clear corneal incision under retrobulbar anesthesia. For visualizing the anterior capsule, 0.3 mL of ICG 0.5% dye was injected through a side-port paracentesis. An ophthalmic viscosurgical device, sodium hyaluronate 2.3% (Healon5), was used to stabilize the anterior chamber. During the continuous curvilinear capsulorhexis, gradual intense staining of the filtering bleb was observed as the ICG dye passed into the bleb (Video 1). Uneventful cataract extraction by phacoemulsification was subsequently performed with in-the-bag implantation of a posterior chamber single-piece monofocal hydrophobic acrylic IOL (Acrysof IQ model SN60WF, Alcon Laboratories, Inc.).On the first postoperative day, the corrected distance visual acuity and IOP in the right eye were 20/25 and 8 mm Hg, r...