ORIGINAL RESEARCH
Ophthalmology
doi: 10.25005/2074-0581-2025-27-3-640-650
UTILIZING A 3D MODEL AS AN ALTERNATIVE TO TRYPAN BLUE STAINING FOR THE VISUALIZATION OF THE ANTERIOR LENS CAPSULE DURING CATARACT SURGERY

A.V. ZHURAVLYOV, V.S. STEBNEV

Department of Eye Diseases, Institute of Postgraduate Education, Samara State Medical University, Samara, Russian Federation

Objective: To assess the clinical efficacy and safety of a new technique for visualizing the anterior lens capsule (ALC) during the anterior capsulorhexis maneuver. This method utilizes a three-dimensional (3D) visualization system and does not require the use of the technically invasive trypan blue (TB) dye staining.

Methods: The study population was divided into two groups: the main group (MG) and the control group (CG). The MG consisted of 250 patients who underwent cataract surgery using a 3D visualization system. This system employs black-and-white filters and reduced color saturation to improve visibility during capsulorhexis. In contrast, in the CG, which also consisted of 250 patients, conventional microscope imaging with TB dye (0.05%) staining for ALC visualization was utilized.

Results: The patients in the MG and the CG exhibited a low rate of intraoperative and postoperative complications, with only 8 cases out of 500 eyes operated, resulting in a complication rate of 1.6%. There were no statistically significant differences between the MG and CG regarding best-corrected visual acuity (BCVA) and uncorrected visual acuity (UCVA) (p>0.05). The average surgical time was 10.2 minutes for the MG and 11.1 minutes for the CG (p>0.05). However, there was a statistically significant increase in the capsulorhexis time in the MG (p<0.05), as well as in the intraocular lens (IOL) implantation time in the CG (p<0.05). Additionally, significantly lower light intensity was used in the operating microscope for the MG, averaging 17.2%, compared to 47.9% for the CG (p<0.05). In the MG, there was a significantly lower incidence of the capsulorhexis radial tear at 0.8% of patients, compared to 4.0% in the CG (p<0.05). The peripheral runaway capsulorhexis was observed in 0.4% of patients in the MG, while it occurred in 1.6% of patients in the CG (p>0.05).

Conclusion: The visualization of the ALC using a 3D system and black-and-white filters is currently of interest for cataract surgery, serving as an alternative to the standard visualization method that employs TB dye.

Keywords: Ophthalmic surgery, three-dimensional visualization, cataract, capsulorhexis.

Download file:

References
  1. Cionni RJ, Snyder ME, Osher RH. Cataract surgery. In: Duane's Clinical Ophthalmology. 1998;6:6. 36 p.
  2. Sanders DR, Higginbotham RW, Opatowsky IE, Confino J. Hyperopic shift in refraction associated with implantation of the single-piece Collamer intraocular lens. J Cataract Refract Surg. 2006;32(12):2110-2. https://doi.org/10.1016/j. jcrs.2006.07.030
  3. Chang YS, Tseng SY, Tseng SH. Comparison of dyes for cataract surgery. Part 2: Efficacy of capsule staining in a rabbit model. J Cataract Refract Surg. 2005;31(5):799-804. https://doi.org/10.1016/j.jcrs.2004.09.029
  4. Eckardt C, Paulo EB. Heads-up surgery for vitreoretinal procedures: An experimental and clinical study. Retina. 2016;36(1):137-47. https://doi. org/10.1097/IAE.0000000000000689
  5. Savastano A, Ripa M, Savastano MC, De Vico U, Caporossi T, Kilian R, et al. Comparison of novel digital microscope using integrated intraoperative OCT with Ngenuity 3D visualization system in phacoemulsification. Can J Ophthalmol. 2023;58(2):162-7. https://doi.org/10.1016/j.jcjo.2021.08.017
  6. Nielsen E. Innovation in 3D ophthalmic visualization: B&L’s SeeLuma digital surgical microscope. Ophthalmology Times. 2022;4:87-9.
  7. Gonzalez-Saldivar G, Chow DR. Comparison of simulated surgical skills using different camera aperture settings for digitally assisted vitreoretinal surgery. J Vitreoretin Dis. 2019;3(5):328-31. https://doi.org/10.3928/23258160-20200401-02
  8. Rosenberg ED, Nuzbrokh Y, Sippel KC. Efficacy of 3D digital visualization in minimizing coaxial illumination and phototoxic potential in cataract surgery: Pilot study. J Cataract Refract Surg. 2021;47(3):291-6. https://doi.org/10.1097/j. jcrs.0000000000000448
  9. Dogra M, Singh SR, Dogra MR. Operating microscope and endoilluminator- induced retinal phototoxic maculopathy after trans-scleral sutured posterior chamber intraocular lens. Indian J Ophthalmol. 2019;67(5):692-4. https://doi. org/10.4103/ijo.IJO_1233_18
  10. Gonzalez-Saldivar G, Chow DR. Optimizing visual performance with digitally assisted vitreoretinal surgery. Ophthalmic Surg Lasers Imaging Retina. 2020;51(4):S15-S21. https://doi.org/10.3928/23258160-20200401-02
  11. Agranat JS, Miller JB, Douglas VP, Douglas KAA, Marmalidou A, Cunningham MA, et al. The scope of three-dimensional digital visualization systems in vitreoretinal surgery. Clin Ophthalmol. 2019;13:2093-6. https://doi.org/10.2147/OPTH. S213834
  12. Melo AGR, Conti TF, Hom GL, Greenlee TE, Cella WP, Talcott KE, et al. Optimizing visualization of membranes in macular surgery with heads-up display. Ophthalmic Surg Lasers Imaging Retina. 2020;51(10):584-7. https://doi. org/10.3928/23258160-20201005-06
  13. Ripa M, Kopsacheilis N, Kanellopoulou K. Three-dimensional heads-up vs. standard operating microscope for cataract surgery: A systematic review and meta-analysis. Diagnostics. 2022;12(9):2100. https://doi.org/10.3390/ diagnostics12092100
  14. Sandali O, Tahiri JHR, Balamoun AA, Duliere C, El Sanharawi M, Borderie V. Use of black-and-white digital filters to optimize visualization in cataract surgery. J Clin Med. 2022;11(14):4056. https://doi.org/10.3390/jcm11144056

Authors' information:

Zhuravlyov Anton Vladimirovich,
Postgraduate Student, Department of Eye Diseases, Institute of Postgraduate Education, Samara State Medical University
ORCID ID: 0000-0003-4536-8098
SPIN: 4507-8301
E-mail: zhuranton@inbox.ru

Stebnev Vadim Sergeevich,
Doctor of Medical Sciences, Professor of the Department of Eye Diseases, Institute of Postgraduate Education, Samara State Medical University
ORCID ID: 0000-0002-4539-7334
E-mail: vision63@yandex.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Zhuravlyov Anton Vladimirovich
Postgraduate Student, Department of Eye Diseases, Institute of Postgraduate Education, Samara State Medical University

443099, Russian Federation, Samara, Chapaevskaya str., 89

Tel.: +7 (987) 9129582

E-mail: zhuranton@inbox.ru


This work is licensed under a Creative Commons Attribution 4.0 International License.

Materials on the topic:
  1. OPEN GLOBE INJURIES: CLINICAL FEATURES AND OUTCOMES OF TREATMENT
  2. A NEW METHOD OF ASSESSING OCULAR INFLAMMATION IN THE ANTERIOR SEGMENT USING SOFTWARE
  3. OCULAR CHANGES DURING PREGNANCY
  4. RETINAL ASTROCYTIC HAMARTOMA: CLINICAL FEATURES
  5. PEDIATRIC POSTTRAUMATIC ENDOPHTHALMITIS IN TAJIKISTAN
  6. EFFECT OF INTRACAMERAL IMPLANTATION OF PLASMA-MODIFIED POLYLACTIC ACID FILMS ON THE COURSE OF IN VIVO-INDUCED BULLOUS KERATOPATHY
  7. ASSESSMENT OF EFFICACY AND SAFETY OF COMBINED MICROINVASIVE LASER-SURGICAL TREATMENT OF RHEGMATOGENOUS RETINAL DETACHMENT
  8. EPIDEMIOLOGY OF THE PEDIATRIC EYE INJURIES IN THE SUGHD REGION OF TAJIKISTAN
  9. LAMELLAR KERATOPLASTY WITH THE CROSS-LINKING APPLICATION IN TREATMENT OF KERATOCONUS

◄ Back to the list