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

Abstract

Objective: 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?" Methods: 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. Results: 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. Conclusion: 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.

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

“…Our comparative results substantiated that staining the internal surface of LECs in vitro has shown a significant detrimental effect on LECs along with the density of cells without producing statistically significant splitting and loss of intactness of the basement membrane in the concentration of 0.06% TB used for 10 s. This indicates that TB is toxic to LECs without disrupting the bag’s integrity. [ 10 11 12 13 14 15 16 17 ] Therefore, our study gives basic research and histomorphology support for future studies by routine in vivo staining of the capsular bag for 10 s and thorough wash before IOL implantation and following the patients for incidence of PCO. Further studies with more sample sizes, lower concentrations of TB, and duration of staining can also be considered to optimize the results.…”

“…The types of degeneration seen in our study are one case of cytoplasmic, one case of vacuolar, one case of focal, and three cases of partial degeneration, implying that TB might be responsible for different types of degeneration. [ 10 11 ] In a study by Pankaj Sharma et al .,[ 10 ] it was observed that injecting the TB 0.1% into the capsular bag following phacoemulsification and inserting hydrophilic acrylic IOL reduced PCO. Here in this study, they did the internal staining of the capsule with TB, and our study provides histomorphology evidence for its safe use for the abovementioned purpose.…”

“…A study done by Aminatu Abdul Rahman et al . [ 11 ] revealed that TB helps in the completeness of PCCC during pediatric cataract surgery. Our analysis also supports the use of TB in internal staining of the capsular bag for visualization of the posterior capsule in the concentration of 0.06% without compromising the intactness of the capsular bag.…”

“…Systematic reviews have revealed that staining of the posterior capsule (capsular bag) with TB helps in the completeness of posterior CCC (PCCC) and proper positioning of IOL in pediatric cataract surgery along with the prevention of PCO without affecting the integrity of the capsular bag. [ 11 ] Our study aims to provide the histomorphological support of the above use by comparing the effects of staining of both sides with only external side staining of the lens capsule on epithelial cells, density, viability of LECs, and lens capsule integrity during cataract surgery.…”