New stains for anterior capsule surgery.

PURPOSE: To investigate whether new dyes and dye combinations can give equivalent or better staining in anterior capsule surgery than existing dyes with a low degree of toxicity on relevant cells. SETTING: University laboratory of Jacobs University Bremen, Germany. DESIGN: Laboratory experimental study. METHODS: Pig eyes were collected post mortem. Cataract was induced by microwave irradiation. Access to the lens capsule was through open-sky surgery. Staining was performed and results were documented by photography. The toxicity of the dyes was evaluated in 3 different cell lines immediately after exposure and with a delay of 24 hours, with exposure in the dark or subsequent strong illumination. RESULTS: A new cyanine dye, BIP (2-[5-[3,3-dimethyl-1-(4-sulfobutyl)-1,3-dihydro-indol-2-ylidene]-penta-1,3-dienyl]-3,3-dimethyl-1-(4-sulfobutyl)-3H-indolium sodium), was found to lead to green staining, with reduced toxicity on corneal endothelial cells. Staining could be further enhanced by combining it with trypan blue. Methylene blue was very toxic, whereas its combination with trypan blue was much less toxic. CONCLUSIONS: With BIP alone or in combination with trypan blue, safe staining of the capsule can be achieved, resulting in a green color.

Toxicity and phototoxicity in human ARPE-19 retinal pigment epithelium cells of dyes commonly used in retinal surgery.

PURPOSE: To compare, for the first time, systematically the toxicity and phototoxicity of dyes and dye combinations used in vitreoretinal surgery. The dyes were trypan blue, brilliant blue G, trypan blue + brilliant blue G, indocyanine green, bromophenol blue, bromophenol blue + brilliant blue G, and acid violet 17, in clinically used concentrations. METHODS: Human ARPE retinal pigment epithelium cells were exposed to the dyes for 30 min. For phototoxicity, the cells were exposed for 15 min to high-intensity light from a light emitting diode source with an intensity similar to surgical conditions. Toxicity was assayed either directly after exposure to either dye alone or dye and light, or with a delay of 24 h. RESULTS: None of the dyes or their combinations was toxic when cells were exposed to them at ambient light. Acid violet led to a reduction viability by 90% already immediately after light exposure. Bromophenol blue and its combination with brilliant blue G showed strong phototoxicity (reduction of viability by 83%) when assayed with delay. Indocyanine green with different agents to adjust osmolarity (balanced salt solution, glucose, and mannitol) was not found to be toxic. CONCLUSION: The strong immediate phototoxicity of acid violet reflects its clinical toxicity. Bromophenol blue might also be disadvantageous for patient outcome because of its delayed phototoxicity. The other dyes (trypan blue, brilliant blue g, and indocyanine green) were not found to be toxic neither with exposure to ambient light nor after exposure to light of intensities used in surgery.