"Visco–Shell" Staining Technique of the Anterior Capsule for Mature White Cataracts.

Abstract

Abstract: : Purpose: Introduction of a new and inexpensive technique for staining the anterior capsule of white cataracts to improve visualization during continuous curvilinear capsulorhexis. Methods: The Visco–Shell stain was applied to the anterior capsule of six mature white cataracts with no red reflex. The stain required .5cc of Balanced Salt Solution, which was dyed to a bright orange with a fluorescein strip. Viscoelastic, such as Healon, Provisc, Ocucoat, was mixed with the stain for a total volume of 1cc. The fluorescein stain was then aspirated into a PPD syringe. A 30–gauge blunt irrigating canula was applied to the syringe making the stain ready for application to the anterior capsule. A superior scleral tunnel was used in all six cases, allowing for easy transition to extracapsular cataract extraction if necessary. A paracentesis port was placed 2½ clock hours to the left hand side of the scleral tunnel using a super sharp blade. A protective upper shell of a more viscous viscoelastic, in this case Healon GV, was injected into the anterior chamber to prevent staining of the corneal endothelium by the fluorescein dye. The stain was carefully painted onto the surface of the anterior capsule and left in place for approximately two minutes before removal with irrigation. Continuous curvilinear capsulorhexis was then performed with the improved visualization of the capsule. The cataracts were then removed with phacoemulsification followed by implantation of an intraocular lens. Results: Six mature white cataracts were stained using the "Visco–Shell" technique. The improved visualization of the anterior capsule allowed for uncomplicated completion of the capsulorhexis with subsequent removal of the cataract. There was no residual staining of the corneal endothelium, iris or intraocular lens with the fluorescein. No other side effects noted with up to six month follow up. Conclusions: The materials required for the "Visco–Shell" technique are inexpensive and readily available in the operating room compared to other capsular staining methods. This staining method provided improved visualization during capsulorhexis and should be considered a reasonable alternative to ICG and Trypan Blue due to its reduced cost, accessibility and lack of known side effects.

Keywords: cataract • color appearance/constancy • training/teaching cataract surgery