Indocyanine green-assisted phacoemulsification in cases of complicated or simple advanced cataracts.

BACKGROUND/PURPOSE: During phacoemulsification for advanced cataracts, particularly when complicated by anterior segment abnormalities, capsulorhexis is very difficult and carries a high risk of complications. This study investigated the efficacy and safety of indocyanine green (ICG)-assisted phacoemulsification in complicated or simple advanced cataracts. METHODS: Thirty-two patients (35 eyes) underwent phacoemulsification for complicated advanced cataracts (group 1) or simple advanced (mature/hypermature) cataracts (group 2). Anterior segment abnormalities (corneal opacity, small pupil, or glaucoma) in group 1 complicated phacoemulsification. In both groups, 0.5% ICG was used for capsulorhexis, and subsequent procedures were performed in the same routine manner. RESULTS: Group 1 included 15 patients (17 eyes) with a mean age of 60.0 years. Group 2 included 17 patients (18 eyes) with a mean age of 69.4 years (p<0.05). Continuous curvilinear capsulorhexis was completed in all eyes in group 2, but radial tears occurred in four (23.5%) eyes in group 1 (p<0.05). Phacoemulsification was performed uneventfully in all eyes in both groups. Postoperative complications (corneal edema, vitreous prolapse, posterior capsule opacity, elevated intraocular pressure) were seen in five (27.8%) eyes in group 1 and four (23.5%) eyes in group 2 (p>0.05). None of these were attributed to the use of ICG. Visual acuity improved in all eyes in group 2, but in only 11 (64.7%) in group 1 (p<0.01). CONCLUSION: ICG-assisted phacoemulsification is safe and helpful for complicated or simple advanced cataracts. Differences between the two groups in patient age, intraoperative complications, and visual outcome could be explained by differences in the cause(s) of advanced cataracts.

Comparison of dyes for cataract surgery. Part 1: cytotoxicity to corneal endothelial cells in a rabbit model.

PURPOSE: To investigate the corneal endothelial cytotoxicity of dyes for capsule staining in cataract surgery. SETTING: Department of Ophthalmology and Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan. METHODS: Cultured corneal endothelial cells of New Zealand white rabbits were exposed for 1 minute to 1 of the following dyes (various concentrations): indocyanine green (ICG), methylene blue (MB), gentian violet (GV), trypan blue (TB), and fluorescein sodium (FS). The degree of cell damage was determined by in vitro staining with TB and comparison with results in a control group. The effect of longer exposure (up to 10 minutes) to ICG 0.25% was also investigated. Structural changes in corneal endothelial cells after dye exposure were evaluated by light microscopy and transmission electron microscopy (TEM). RESULTS: Indocyanine green 0.25%, MB 0.20%, GV 0.01%, TB 0.40%, and FS 10% did not induce significant damage to corneal endothelial cells. Significant cytotoxicity was observed with the following or higher dye concentrations: ICG 0.50%, MB 0.50%, and GV 0.10%. Exposure to ICG 0.25% for 1 to 10 minutes showed a trend toward cytotoxicity after 10 minutes. On TEM, corneal endothelial cells that had been exposed to ICG 0.50% showed remarkable organelle swelling and disruption, electron-dense granules, and cell lysis. CONCLUSION: One minute of exposure to ICG 0.25%, MB 0.20%, GV 0.01%, TB 0.40%, and FS 10% appeared to be safe as determined by no cytotoxic effects on rabbit corneal endothelial cells in culture.