The effects of trypan blue use on the corneal endothelium during cataract surgery in patients with pseudoexfoliation syndrome (PEX).

PURPOSE: In the present clinical study, it was aimed to investigate the possible effects of Trypan blue (TB) use on the corneal endothelium during cataract surgery in eyes with pseudoexfoliation syndrome (PEX) during a three-month follow-up period using the contralateral eye control design. METHODS: This prospective, randomised controlled, individual cohort study included 92 eyes of 46 patients with bilateral PEX and cataracts. While 1% TB was applied to one eye of the patients before capsulorhexis (study group), it was not applied to the other eye (control group). Both groups were compared preoperatively and postoperatively in terms of endothelial cell density (ECD), endothelial cell loss (%), pleomorphism, polymegathism and central corneal thickness (CCT) using specular microscopy. RESULTS: Preoperative corneal ECD was measured as 2362.56 ± 253.27 in the study group, 2380.84 ± 220.54 in the control group, and 2145.58 ± 221.71 in the study group and 2184.97 ± 200.94 cells/mm2 in the control group in the postoperative 3rd-month follow-up (p = 0.71 and = 0.37, respectively). In addition, there were no significant differences between the two groups in terms of the percentage of hexagonal cells, coefficient of variation (CV), and CCT both preoperatively and postoperatively 3 months later (p = 0.78, =0.39, =0.95 preoperatively and p = 0.31, =0.26, =0.83 postoperatively, respectively). CONCLUSION: This study demonstrated that the injection of 1% TB into the anterior chamber for staining the anterior capsule during cataract surgery did not cause significant corneal endothelial changes at postoperative 3rd months, despite the increased fragility of corneal endothelial cells in patients with PEX.

Characterization of Endothelial Cell Loss in Pre-Descemet Endothelial Keratoplasty Graft Preparation.

PURPOSE: To characterize the pattern and factors affecting endothelial cell loss (ECL) in pre-Descemet Endothelial Keratoplasty (PDEK) graft preparation. METHODS: A prospective study was performed to characterize the pattern of ECL and the impact of inflation pressure in PDEK. Donor corneas were randomized to inflation with air versus Optisol GS storage media. PDEK preparation was performed under continuous pressure monitoring. Trypan blue was used to grade the tissue as acceptable (<25% ECL) or unacceptable (≥25% ECL). Rate of unacceptable ECL was correlated with injection media type and inflation pressure. A retrospective study was then performed of all attempted PDEK preparations at Lions Gift of Sight to evaluate impact of donor tissue factors on ECL. Donor age and tissue preservation time were evaluated and correlated with ECL with PDEK bubbling. RESULTS: Twenty-five corneas were tested prospectively. A reticular pattern of ECL that varied in severity occurred with bubbling. There was no difference in peak inflation pressure or mean expansion pressure between air (706.0, 510.7 mm Hg) and Optisol GS (852.9, 653.0 mm Hg). Increasing peak inflation pressure and mean expansion pressure were associated with an increased risk for unacceptable ECL. On retrospective evaluation of 131 attempted PDEKs, only 44.0% of cases with successful bubbles had acceptable endothelium after processing. Increasing donor age and decreasing preservation time were associated with increased rates of acceptable endothelium. CONCLUSIONS: PDEK processing can result in a reticular pattern of ECL. Higher inflation pressures are associated with greater ECL. Older donor tissues with shorter preservation times might be preferable for PDEK.

Role of Vital Dyes in Chromovitrectomy.

ABSTRACT: Chromovitrectomy, the intraocular application of dyes to assist visualization of preretinal tissues during vitreoretinal surgery, was introduced to avoid ocular complications related to internal limiting membrane peeling, inadequate removal of the vitreous, and incomplete removal of epiretinal membranes. Since 2000, chromovitrectomy has become a popular approach among vitreoretinal specialists. The first vital dye used in chromovitrectomy, indocyanine green, facilitated identification of the fine and transparent internal limiting membrane. Following indocyanine green, trypan blue was introduced to identify epiretinal membranes, and triamcinolone acetonide stained the vitreous well. Recently, additional natural dyes such as lutein and anthocyanin from the açaí fruit have been proposed for intraocular application during vitrectomy. The main goal of this review was to study the role of vital stains in chromovitrectomy and report the latest findings in the literature.

Comparative effects of commonly used intraocular dyes on the viability of human retina Müller cells.

This study investigated the in vitro effect of various vital dyes in common clinical use on human Müller cell viability, and it compared the toxicity of these dyes using a cell culture model. Müller cells were exposed to a series of concentrations (1 %, 0.5 %, 0.25 %, and 0.125 % or 12.9 mM, 6.45 mM, 3.22 mM and 1.61 mM) of Indocyanine green (ICG) for 2, 24, 48, and 72 h. Similarly, groups of Müller cells were stained with "Heavy" brilliant blue G (HBBG), Trypan blue (TB) (0.15 %, or 1.56 mM), Membrane-blue-dual (MBD), and ICG (0.25 %, or 3.22 mM) or BBG (0.025 %, or 0.3 mM) with glucose (GS) (50 %, 66 % and 75 % or 2.78 M, 3.67 M and 4.17 M) for 30, 60, and 120 s. Cell viability was measured with the Cell Counting Kit-8 (CCK-8) and Lactate Dehydrogenase (LDH) release assays. We found that high stain concentration and long exposure time resulted in increased toxicity to Müller cells. Nevertheless, ICG seemed to be safe at the clinically relevant concentration of 0.25 % (3.22 mM) in the short time of exposure. TB was safer than both HBBG and MBD, especially HBBG. Hypertonic GS as a dilution was not safe for Müller cells, and the negative effect was more obvious in 0.025 % (0.3 mM) BBG than that in 0.25 % (3.22 mM) ICG. This is the first report to observe the cytotoxicity of commonly used stains in clinical on human Müller cells in vitro, and to provide some basis for further studies, including in vivo investigation.

Ab Interno Canaloplasty in Open-angle Glaucoma Patients Combined With In Vivo Trypan Blue Aqueous Venography.

PURPOSE: To demonstrate canalogram patterns observed when trypan blue tracer is combined with oculoviscoelastic device during ab interno canaloplasty, and discuss surgical results and potential implications for diagnosis, prognosis, and treatment. METHODS: This is a retrospective small case series study. RESULTS: The authors performed this procedure on 5 patients with informed consent with 4 to 18 months of follow-up. All procedures have been complication free. The average preoperative intraocular pressure was 16.4 mm Hg with an average number of topical glaucoma medications being equal to 3.6. Postoperatively, the average intraocular pressure for the group was reduced to 13 mm Hg with a concurrent drop in the average number of topical medications used equaling 1.8. CONCLUSIONS: Currently, there are limited practical options to evaluate the patency of the aqueous outflow system in our patients. The primary purpose of this paper is to describe canalogram patterns observed during ab interno canaloplasty with trypan blue. This technique may allow us to further our understanding of the aqueous outflow system and its role in the underlying pathophysiology of glaucoma. Further research is required to evaluate the prognostic and diagnostic significance of this technique.

Evaluation of mechanical resistance to tearing of the anterior lens capsule after staining with different concentrations of trypan blue.

PURPOSE: To evaluate and compare the mechanical resistance to tearing of the anterior lens capsule opening after staining with different concentrations of trypan blue in ex vivo porcine eyes. SETTING: Semmelweis University, and Budapest University of Technology and Economics, Budapest, Hungary. DESIGN: Experimental study. METHODS: The study comprised 75 porcine eyes. The capsule was unstained in the Control Group (n = 25 eyes), 0.06% trypan blue was used to stain the capsule in Stained 1 Group (n = 25 eyes), and 0.1% trypan blue was used to stain the capsule in Stained 2 Group (n = 25 eyes). After capsulorhexis, the capsule openings were stretched with custom-designed testing equipment until they ruptured. The rupture force (RF), circumference stretching ratio (CSR), and secant modulus at 10 mN (SM10mN) and 50 mN (SM50mN) were evaluated. RESULTS: In total, 75 eyes were enrolled. There were no statistically significant differences in the RF (P = .8924) or CSR (P = .3876) among the groups. There were no statistically significant differences in the SM10mN (P = .8215) or SM50mN (P = .4184) among the groups. CONCLUSIONS: In this porcine eye model, the trypan blue concentrations that are routinely used in cataract surgery had no effect on capsular rim stability.

Use of trypan blue as an aqueous tracer dye to investigate hypotony where cyclodialysis cleft is suspected.

IMPORTANCE: A new method to help diagnose suspected cyclodialysis clefts. BACKGROUND: To study the use of trypan blue stained aqueous flow patterns in diagnosing causes of hypotony where cyclodialysis clefts were suspected. DESIGN: A case series in a tertiary care centre. PARTICIPANTS: Ten subjects presenting with persistent hypotony and retinal changes. METHODS: Trypan blue was injected into the anterior chamber. MAIN OUTCOME MEASURES: The pattern of dye flow in the anterior chamber was categorized. Intraocular pressure prior to surgery was recorded. RESULTS: All seven subjects with cyclodialysis clefts had a preferential flow to the cleft region. Two hypotonous subjects post trabeculectomy had rapid (5 seconds) and extensive lymphatic staining (6 o'clock hours extent) without visible bleb formation. CONCLUSIONS AND RELEVANCE: Preferential flow of dye to the limbus is a reliable sign of cyclodialysis cleft and helps localize cleft extent. A new cause of hypotony, "lymphatic overdrain," is identified.

Use of trypan blue to assess lymphatic function following trabeculectomy.

IMPORTANCE: To illustrate the importance of lymphatic drainage in assessing trabeculectomy bleb function using intracameral trypan blue. BACKGROUND: To study the lymphatic drainage of trabeculectomy blebs using trypan blue, correlate with bleb function and classify them accordingly. DESIGN: Prospective cross-sectional study in a tertiary care centre. PARTICIPANTS: Thirteen glaucoma patients post-trabeculectomy were studied. METHODS: Trypan blue was injected into the anterior chamber. MAIN OUTCOME MEASURES: The duration taken for dye to stain a drainage bleb or lymphatics is recorded. The extent of the lymphatic structures were measured in clock hours. Intraocular pressure (IOP) prior to surgery was recorded. RESULTS: Eight post-trabeculectomy subjects with dye stained lymphatic vessels had lower IOP (12.6 mmHg, P = .013) compared to the five with no lymphatic vessel staining (mean IOP 23.6 mmHg). Lymphatic extent was inversely related to IOP (P = .021). CONCLUSIONS AND RELEVANCE: Eyes with lymphatic connections to drainage blebs had lower IOP and reduced requirement for topical medications. The extent of lymphatic connection to drainage blebs is related to lower IOP.

Efficacy and safety of a new selective laser device to create anterior capsulotomies in cataract patients.

PURPOSE: To compare the efficacy and safety of anterior capsulotomy creation with a new selective laser device (CAPSULaser) with those of manual capsulotomies. SETTING: GEMINI Eye Clinic, Zlin, Czech Republic. DESIGN: Prospective case series. METHODS: Patients were placed in cohorts based on age and cataract grade and randomly allocated to have laser capsulotomy or manual continuous curvilinear capsulorhexis (CCC). The anterior capsule was stained with microfiltered trypan blue 0.4%. The anterior capsulotomy was created with the laser device focused on the anterior capsule through a custom patient interface lens. Intraoperative video analysis with the use of an intraocular ruler and postoperative examinations were used to assess safety and efficacy (accuracy of capsulotomy size, circularity, centration). RESULTS: No intraoperative complications occurred in the laser group or the manual group. All capsulotomies in the laser group were free-floating with no tags or tears. The mean capsulotomy diameter was 5.03 mm overall (range 4.8 to 5.2 mm, laser group; 4.4 to 5.8 mm, manual group). In the laser group, all the capsulotomies were within 0.1 mm ± 0.1 (SD) of the target. The circularity accuracy was greater than 99.0% ± 1.0%; the mean centration of the capsulotomy in relation to the intraocular lens (IOL) was 0.1 ± 0.1 mm. All parameters were statistically significant (P < .01). The IOL-capsulotomy overlap was 360 degrees in all laser cases. CONCLUSIONS: Selective laser capsulotomy using a new proprietary trypan blue formulation was safe and effective in cataract surgery. The sizing, circularity, and centration of the laser capsulotomy were more accurate than those of the manual CCC, resulting in consistent 360-degree IOL coverage.

Banded technique for pediatric traumatic cataract surgery.

We describe a technique for pediatric traumatic cataract management in cases in which part of the anterior capsule has been ruptured. The technique requires creating a 2-incision push-pull capsulorhexis in the intact anterior capsule. The capsulorhexis is made in a manner that converts the edge of the ruptured anterior capsule into a band of capsule that holds the intraocular lens (IOL) in the bag, reducing the incidence of early, intermediate, or late postoperative lens-iris capture. It also reduces the chances of IOL displacement.

AIR/FLUID-DROPPING TECHNIQUE FOR INTRACAPSULAR DISTILLED WATER APPLICATION: A Vitrectomy Approach for Selective Targeting of Lens Epithelial Cells.

PURPOSE: We describe a simplified technique of intracapsular distilled water application for targeting lens epithelial cells using vitrectomy approach of fluid-air exchange and to evaluate the reliability and safety of this technique. METHODS: Consecutive patients with cataract were randomly assigned to treatment group and control group. After the nucleus removal and cortical aspiration, the space of anterior chamber and capsular bag were maintained with continuous infusion of sterile air by using fluid-air exchange technique through side-port incision. Distilled water was dropped into the capsular bag using a specially designed syringe. A concave air-fluid surface (a physical phenomenon) insured the contact of distilled water with the inner surface of the capsule without overflowing from the bag. The distilled water remained in place for 3 minutes and was then removed by the syringe. RESULTS: No intraoperative surgical complication was observed, and no damage to adjacent intraocular structures was observed during the postoperative follow-up. There was no statistical difference of corneal endothelial cell loss between the treatment group and the control group. Histological study confirmed damage to the lens epithelial cells from anterior capsular specimens treated by the technique. CONCLUSION: The simplified technique using vitrectomy approach is safe and specific for targeting lens epithelial cells without associated complications.

Using intracameral vital dye as a guide for venting incision in acute corneal hydrops.

PURPOSE: To introduce a new surgical technique for the localization of corneal bulla to drain a massive corneal hydrops. METHODS: Four consecutive cases with acute large protruded hydrops were selected. A limbal paracentesis was made via 15° blade. Afterward, trypan blue with a concentration of 0.1% was injected into the anterior chamber. Upon pooling trypan blue in the bulla, the surgeon immediately marked the primary site of stromal staining before further spreading of the dye. Anterior chamber irrigation was then carried out using balanced salt solution, and the excess of trypan blue was washed out. Subsequently, the surgeon made a beveled venting incision to decompress bulla via 15° blade resulting in a stream of dye egressed from the venting incision. At the end of the surgery, 20% diluted SF6 was injected into the anterior chamber. RESULTS: Postoperatively, Descemet's membrane was attached up to the second postoperative day. The corneal edema was resolved up to 3 weeks. Contact lens-corrected visual acuity was improved in all cases. CONCLUSION: Venting incision under the guide of injected trypan blue into the anterior chamber combined with intracameral SF6 injection could be effectively used for a large acute hydrops. This technique could prevent other interventions like passing full-thickness corneal suturing and subsequent complications.

A Novel Use of Trypan Blue During Canalicular Glaucoma Surgery to Identify Aqueous Outflow to Episcleral and Intrascleral Veins.

PURPOSE: We describe a novel technique comprising the use of trypan blue to confirm aqueous outflow to collector channels and aqueous veins after goniotomy with the Kahook Dual Blade (New World Medical, Rancho Cucamonga, CA). Intraocular dyes have been safely used during ophthalmic surgery to evaluate the patency of the trabecular meshwork and collector channels. Further, trypan blue has been safely used to stain the anterior capsule of the lens in cataract surgery, to enhance visualization for capsulorhexis; similarly, trypan blue has been safely used to stain the trabecular meshwork for enhanced visualization during glaucoma angle surgery. Channelography enables evaluation of the collector channels during canaloplasty with fluorescein dye; episcleral fluid wave enables evaluation of the intraoperative structural patency of the conventional outflow system, from the anterior chamber to the episcleral and conjunctival distal collectors after Trabectome goniotomy (NeoMedix Corporation, Tustin, CA). PATIENTS AND METHODS: We evaluated 4 cases of glaucoma patients who underwent goniotomy with the Kahook Dual Blade to observe whether trypan blue could identify the patency of Schlemm's canal and aqueous egress to episcleral and intrascleral veins. RESULTS: We successfully confirmed the outflow pathway via Schlemm's canal and collector channels with trypan blue in 3 of the 4 cases. CONCLUSIONS: We conclude that trypan blue can be used safely to confirm both aqueous outflow and the patency of Schlemm's canal and aqueous veins during canalicular glaucoma surgery.

New Vital Dye Injection Technique With Vitrectomy Probe.

BACKGROUND AND OBJECTIVE: To evaluate a new, safer way to inject vital dye during chromovitrectomy for dye-assisted macular peeling. PATIENTS AND METHODS: Prospective consecutive case series. Enrolled patients underwent macular surgery with a new technique of staining the epiretinal membrane and the internal limiting membrane with vital dyes. Twenty eyes of 20 patients (eight men, 12 women) were affected by idiopathic epiretinal membrane and underwent 25-gauge via pars plana vitrectomy for epiretinal membrane removal. Ten eyes were stained with Membrane Blue-Dual (Brilliant Blue G + trypan blue; DORC, Zuidland, The Netherlands) and 10 eyes were stained with Brilliant Peel (Brillant Blue G; Fluoron GmbH, Ulm, Germany). Preoperatively and postoperatively (1, 3, and 6 months) all patients received a complete ophthalmologic examination with best-corrected visual acuity (BCVA) assessment, swept-source optical coherence tomography, and multifocal electroretinography (mfERG). RESULTS: The mean age of the patients was 67.0 years ± 8.6 years (range: 55 years to 78 years). No statistically significant difference in BCVA improvement or central foveal thickness decrease was observed in either group (P > .05). The mfERG showed an increase in electrical response densities 3 months after surgery. CONCLUSION: The authors describe a new technique to inject vital dye during chromovitrectomy for dye-assisted macular peeling that may help to improve the overall safety of macular surgery. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:528-533.].

A Novel Approach for Therapeutic Delivery to the Rodent Pancreas Via Its Arterial Blood Supply.

OBJECTIVES: Endovascular techniques can now access the arterial blood supply of the pancreas in humans to enable therapeutics to reach the gland in high concentrations while concurrently avoiding issues related to non-targeted delivery. However, there is no way to replicate this in small animals. In a rat model, we therefore developed a novel non-terminal technique to deliver therapeutics to different regions of the pancreas, via its arterial blood supply. METHODS: In female Wistar rats, selective branches of the celiac artery were temporarily ligated, depending on the region of the pancreas being targeted. Trypan blue dye was then administered as a surrogate marker for a therapeutic agent, via the celiac artery, and its staining/distribution throughout the pancreas determined. Postoperatively, animals were monitored daily, and serum was evaluated for markers of pancreatitis, liver, and metabolic function. RESULTS: Using this technique, we could selectively target the head, body/tail, or entire gland of the pancreas, via its arterial blood supply, with minimal nontarget staining. Following the procedure, all animals recovered with no evidence of pancreatitis or liver/metabolic dysfunction. CONCLUSIONS: Our study demonstrates a novel technique that can be used to selectively deliver therapeutics directly to the rat pancreas in a safe manner with full recovery of the animal.

Safety evaluation of subretinal injection of trypan blue in rats.

OBJECTIVE: To determine the appropriate concentration of trypan blue (TB) for subretinal injection in a rat model and to provide a safety profile that limits retinal toxicity while maintaining dye visibility. MATERIALS AND METHODS: Adult rats were subretinally injected with various concentrations of either TB or phosphate-buffered saline (PBS); rats which received sham injections served as an additional control. The injected areas were visualized under a surgical microscope. Electroretinography (ERG) was performed to measure retinal function. Animals were then sacrificed, and the eyes were sectioned and examined by light microscopy. Terminal deoxynucleotidy1 transferase dUTP nick-end labeling (TUNEL) was applied to determine retinal apoptosis. RESULTS: One day after the subretinal injection, TB stains were visible under the surgical microscope in the 0.2%, 0.08%, and 0.04% TB-injected groups, but not in the 0.02% TB-injected group. TB stain was detectable in the retina and sclera of the 0.2%, 0.08%, and 0.04% TB-injected groups for over 2 weeks after injection. However, the amplitudes of ERGa- and b-waves were affected and became significantly lower in the 0.2% TB-injected group than the amplitudes in the PBS-, or sham-injected group. Moreover, TUNEL+ cells appeared in the outer nuclear layer (ONL), ganglion cell layer (GCL), and retinal pigment epithelium (RPE) layer of the 0.2% and 0.08% TB-injected groups at 1 and 7 days after subretinal injection. In contrast, very few TUNEL+ cells were found in the 0.04% TB- or PBS-injected group. Two weeks after injection, the ONL was significantly thinner in the 0.2% TB-injected group than in the 0.04% TB-, PBS- or sham-injected group. CONCLUSIONS: TB injection induces a dose-dependent neurotoxic effect on retinal cells. Subretinal injection of 0.04% TB is relatively safe and effective for subretinal staining.

Trypan Blue for the Assessment of Filtering Bleb Function During Cataract Surgery.

PURPOSE: Phacoemulsification has been cited as a possible cause of bleb failure in eyes with prior trabeculectomy. No method has been developed to directly evaluate the risk of bleb failure after phacoemulsification. We investigate the use of trypan blue during cataract surgery in the setting of a preexisting trabeculectomy to evaluate the functional status of the bleb and predict postoperative bleb function. MATERIALS AND METHODS: In total, 14 patients contributing 1 eye each with a history of prior trabeculectomy with mitomycin C undergoing phacoemulsification with intraocular lens implantation were enrolled in this prospective, nonrandomized clinical trial. At the time of phacoemulsification, trypan blue was instilled into the anterior chamber before capsulorhexis creation. Staining of the bleb was grouped as being mild or diffuse using intraoperative photographs. These eyes were followed for 1 year postoperatively and evaluated for intraocular pressure (IOP) control. RESULTS: The change in IOP was not significantly different between the 2 groups (P=0.14). A trend towards greater need for IOP-lowering medications was noted (P<0.10) in eyes with mild bleb staining. No statistically significant difference in rates of decreased bleb function was noted at 1-year follow-up after phacoemulsification. CONCLUSION: The intensity of bleb staining with trypan blue during phacoemulsification is not associated with changes in IOP postoperatively. A trend towards decreased need for IOP-lowering medications was noted in eyes with diffuse bleb staining at 1 year after cataract surgery.

Long-term results of trypan blue dye irrigation in the capsular bag to prevent posterior capsule opacification: A randomized trial.

PURPOSE: To study the effect of capsular bag irrigation of trypan blue dye (0.06%) on posterior capsular opacification (PCO) in eyes undergoing phacoemulsification. METHODS: This was a randomized, trial conducted at a tertiary eye care center in central India. The study included 50 patients (100 eyes) with senile cataracts who were scheduled for phacoemulsification and intraocular lens (IOL) implantation and were willing to undergo bilateral cataract surgery. One eye of each patient was randomized to one of two groups. The dye group received 0.2 ml of trypan blue injected in the capsular bag after cortical cleanup under air. The control group (other eye of the same patient) received 0.2 ml of balanced salt solution injected in a similar manner. PCO in the central 3 mm area of IOL optic was analyzed by a masked observer using an evaluation of PCO software computer analysis system at 6, 12, 24, and 36 months. RESULTS: The average age of patients was 62.05 ± 6.22 in the dye group and 64.92 ± 7.16 years in the control group. The mean PCO score at 6 months was significantly lower in the dye group (0.10 ± 0.15) than in the control group (0.22 ± 0.30). There were no significant differences in the PCO scores between the two groups from 12 to 36 months. At the end of 3 years, eight eyes in the dye group and seven in the control group required YAG capsulotomy (P = 0.21). CONCLUSION: Capsular bag irrigation of trypan blue dye decreased the PCO score at 6 months, but it had no effect at 36 months.

Comparison of the mechanical properties of the anterior lens capsule in senile cataract, senile cataract with trypan blue application, and pseudoexfoliation syndrome.

PURPOSE: To evaluate the elastic modulus, hardness, and mechanical properties of the anterior lens capsule in different types of cataract and to assess the correlation with age. SETTING: Baskent University Hospital, Department of Ophthalmology, Ankara, Turkey. DESIGN: Prospective comparative study. METHODS: Patients were divided into 3 groups. Group 1 comprised patients with senile cataract, Group 2 patients had pseudoexfoliation (PXF) syndrome, and Group 3 patients had dye-enhanced cataract surgery. The capsules were analyzed using a nanoindentation device. Young's modulus of elasticity was measured by the Oliver-Pharr method and capsule hardness by the Martens method. RESULTS: The study comprised 72 patients, 24 per group. The mean Young's modulus was 7.53 GPa ± 1.07 (SD) in Group 1, 6.01 ± 1.25 GPa in Group 2, and 8.12 ± 0.98 GPa in Group 3. The capsules in Group 2 were more elastic than in Group 1 and Group 3 (P < .001). The capsules in Group 3 had lower elasticity than in Group 1, although the difference was not significant (P = .94). The mean capsule stiffness was 326.41 ± 98.40 MPa in Group 1, 210.5 ± 52.32 MPa in Group 2, and 315.54 ± 163.15 MPa in Group 3. The lens capsules in Group 2 were less stiff than those in Group 1 and Group 3 (P < .001). CONCLUSIONS: Capsule thickness was positively correlated with increasing age in all groups. The anterior lens capsules of patients with PXF had more elasticity and less stiffness than the other groups. Intracameral trypan blue application had no effect on capsule elasticity and stiffness.