Intraocular Trypan Blue Toxicity Following Complicated Cataract Surgery: A Case Report On Corneal Decompensation And Retinal Risks

To report a case of corneal and potential retinal toxicity caused by the accidental posterior migration and retention of trypan blue dye during cataract surgery complicated by zonular dialysis, and to describe the surgical strategies used for its resolution.

case report

A 54-year-old male undergoing cataract surgery experienced zonular dialysis and vitreous prolapse. After trypan blue staining, the dye migrated into the vitreous cavity, causing a diminished light reflex. The procedure was transitioned to general anesthesia. Management included an anterior vitrectomy and capsular stabilization via a Hoffman pocket with a sutured Capsular Tension Segment. Phacoemulsification was completed with a Capsular Tension Ring and Posterior Chamber Intraocular Lens implantation. Postoperatively, persistent vitreous opacity and corneal decompensation confirmed trypan blue sequestration. On day five, a secondary 3-port Trans Pars Plana Vitrectomy was performed for a dye washout. 

Post vitrectomy, the course included transient bullous keratopathy and IOP fluctuations. Initial VA was 0.4 with corneal edema (pachy 642 µm). By day 14, the ocular surface stabilized: IOP normalized to 18 mmHg, VA improved to 0.6, and ECC was 2503 cells/mm². Subsequent anterior capsular phimosis was successfully treated via YAG laser capsulotomy, improving VA to 1.0. Long-term follow-up confirmed sustained intraocular stability. Transient macular edema noted on OCT fully resolved. At the final 15-month assessment, the patient maintained a stable VA of 1.0, IOP of 14 mmHg, and ECC of 2257 cells/mm², indicating a successful recovery from the initial trypan blue-induced toxicity.

Trypan blue sequestration in the posterior segment can act as a potent chemical irritant, leading to severe corneal decompensation and potential retinopathy. In cases where zonular instability allows dye migration, early TPPV for dye removal is a critical rescue intervention. This stepwise approach effectively mitigates long-term toxicity, facilitating excellent visual recovery and maintaining long-term intraocular stability.