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Corneal edema secondary to inadvertent use of 1% methylene blue for capsular staining in cataract surgery.

Poster Details

First Author: M. Casal Valiño SPAIN

Co Author(s):    G. Garrido   M. Acebes   M. León              

Abstract Details


To present the evolution and management of postsurgical corneal edema after the inadvertent use of methylene blue.


Hospital Universitario de la Princesa, Madrid, Spain


We present two clinical cases in which 1% methylene blue, instead of trypan blue, was used inadvertently to stain the anterior capsule during phacoemulsification, in the same surgical session. The error was detected, due to the excessive staining of the iris, at the end of the second patient's surgery. Both cases presented at 24 hours a corneal edema +3 from limbus to limbus with a normal intraocular pressure and a corneal thickness above 1,000 microns. Oral and hourly topical corticosteroid treatment was prescribed at high doses (1mg / kg /day) in the first week with a subsequent gradual decrease.


At two months, the corneas had regained transparency, although an increase in central pachymetry (508 and 531 microns) and morphological changes in specular microscopy (polymegatism) were maintained.


Despite the known endothelial and iris tissue cytotoxicity of methylene blue, in the anterior chamber, the administration of oral corticosteroids at high doses, as has been used in the toxic syndrome of the anterior segment (TASS), can help to improve the prognosis of the viability of these corneas avoiding their decompensation. It is relevant to highlight the importance of a clear presentation, labeling and storage of the different blue dyes in the operating room and the adequate training of the personnel working there.

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