Iatrogenic Corneal Injury Secondary to Trypan Blue usage during cataract surgeries: A Case Series

Abstract

To report clinical features and management of toxic keratopathy induced by inadvertent intrastromal trypan blue injection (0.06%) during cataract surgery. We report two cases of toxic keratopathy induced by iatrogenic intrastromal trypan blue injection during cataract surgery. The two cases were performed by ophthalmology residents at our centre. Intraoperatively in both cases, trypan blue dye was inadvertently injected into the corneal stromal via side port wound. Surgery was abandoned due to development of corneal oedema. They were treated as toxic keratopathy due to the bluish discoloration of the cornea, generalized (limbal to limbal) panstromal edema and marked Descemet membrane folds. There were epithelial microbullae and mild circumcorneal injection. Both patients’ vision deteriorated with only minimal anterior chamber reaction and normal intraocular pressure. Intensive topical corticosteroid, prophylactic antibiotic, gutt hypertonic saline 5%, and cycloplegic agent eyedrops were given. The cornea edema and staining in both patients resolved completely by 6 weeks. They underwent uncomplicated elective phacoemulsification 3 months after the incident. Intraoperative Iatrogenic inadvertent intrastromal vision blue injection during cataract surgery can cause toxic keratopathy. A decision to abandon the surgery and prompt management to reverse the complication can produce excellent outcome.