Inadvertent Ophthalmic Toxicity Associated With Intracameral Methylene Blue 1%: A Review Of Five Clinical Cases Occurring On The Same Day
Published 2025 - 43rd Congress of the ESCRS
Reference: PO266 | Type: Free paper | DOI: 10.82333/85d7-m905
Authors: Ramin Khoramnia* 1 , Tadas Naujokaitis 2 , Louise Blöck 2 , Katharina Fabian 2 , Lucy Joanne Kessler 2 , Grzegorz Łabuz 2 , Gerd U. Auffarth 2
1Department of Ophthalmology,Carl Gustav Carus Dresden University Hospital,Dresden,Germany;Department of Ophthalmology,University of Heidelberg,Heidelberg,Germany, 2Department of Ophthalmology,University of Heidelberg,Heidelberg,Germany
Purpose
This paper reviews clinical cases of inadvertent ophthalmic toxicity associated with the use of Methylene Blue 1% intracamerak injection instead of trypan blue 0.025%. The cases occurred on the same day in a clinical setting, highlighting the potential risks and complications of this agent when used inside the eye inappropriately.
Setting
The cases were operated in a tertiary care hospital's ophthalmology department, Where Methylene Blue 1% injection used by different other Subspecialties like General Surgery & Urology for various diagnostic and treatment purposes. The incidents occurred within a single day, prompting an immediate review of protocols and practices.
Methods
A retrospective review was conducted on five cases where patients experienced severe ocular toxicity following Methylene Blue 1% injection. Data was collected from medical records, including patient demographics, signs and symptoms reported, effect of the dye on intraocular strucures and clinical management.
Results
All five cases suffered severe picture of Urrets-Zavalia Syndrome secondary to the toxic dye, and bluish discoloration of the posterior capsule, iris, severe corneal edeam and conjunctival staining. ris and capsule discoloration dissappeared from all cases after four weeks, but severe bollus keratopathy developed to all cases except one case where viscoelastic material where used prior to the injection of intracameral dye. All four cases underwent endothilial keratoplasty (EK) ultra-thin Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) and regain 20/40 or better visual acuity after 12 weeks of medical treatment with topical steroid and sodium chloride except one case where EK had primery graft failure.
Conclusions
The cases reviewed highlight the significant risk of inadvertent ophthalmic toxicity associated with Methylene Blue 1% injection. Proper training and double checkup with scrubbing and circulating nurses in operation room are crucial in preventing such incidents. Enhanced awareness among healthcare providers regarding the potential ocular complications of Methylene Blue is essential for improving patient safety and outcomes.