Intraoperative Corneal Incision Evaluation with Trypan Blue Technique

C l i n M e d International Library Citation: Kayikcioglu O, Bilgin S, Ulusoy MO (2016) Intraoperative Corneal Incision Evaluation with Trypan Blue Technique. Int J Ophthalmol Clin Res 3:050 Received: January 12, 2016: Accepted: May 10, 2016: Published: May 13, 2016 Copyright: © 2016 Kayikcioglu O, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Kayikcioglu et al. Int J Ophthalmol Clin Res 2016, 3:050


Introduction
Phacoemulsification surgery is a method which requires small incision and leads to lesser wound site problems compared to surgical procedures with larger incisions [1].In this method, side insertions are hydrated, the main insertion hole heals spontaneously following clear corneal incision technique.Wound site leakage is a known risk factor for early postoperative complications including shallow anterior chamber and acute endophthalmitis [2].These leakages are mostly checked by classical methods intraoperatively and the surgery is finalized in case of non-leakage.The aim of our study was to determine leakages by trypan blue instillation onto main and side insertion holes after phacoemulsification surgery.

Patients and Methods
The observational case series included 34 eyes with cataract of 34 patients.All patients underwent routine phacoemulsification with clear corneal incision and all had a posterior chamber intraocular lens (PCIOL) implantation with injection through the main incision.In this procedure, side port incisions were made by 20-gauge MVR/ stiletto and main incisions were made by 3.0 mm keratome.All of the incisions were hydrated by balanced saline solution at the end of the procedure.Anterior chamber stability was controlled visually.Then incisions were controlled for leakage with the help of a cotton swab.When a leakage was observed, corneal stroma were hydrated until the leakage stopped.When there was no leakage observed, trypan blue was instilled onto main and side insertion holes for final leakage control.A leakage was defined as a clear line in blue background this non-touch technique can be used to detect even minor wound leakage more readily and more distinctly.

Statement of Ethics
This case report description followed the Helsinki Declaration criteria, and written informed consent was obtained from the patient for publication of this article and any accompanying images.The Institutional Review Board and Ethics Committee ruled that approval was not required for this study.
the cornea thereby sealing the wound [6].Whether leakage occurs passively through wound leaks or actively via the squeezing action of the upper lid on the globe or both is not known with any certainly.Also not only may these wound leaks serve as a portal of entry for pathogens and toxic substances but the resulting reduced intraocular pressure may also drop below the threshold enabling gaping of the unhealed wound [6].
Chee et al. in their study, used 5% povidone iodine in order to evaluate wound leakage and suggested that this method was effective for determining wound leakage.In addition, they stated that leakage is high when the corneal main incision is short, and wound site stability is high when the tunnel is long and incision is square shaped [7].In our study, a 2 mm main insertion hole parallel to iris plane was made by using 3 mm keratome in all patients by the same surgeon.None of the patients showed leakage from the main insertion holes.
Use of cellulose sponge is another frequently practiced method, but this is a contact technique and the product is required solely for the purpose of testing wound integrity.Use of trypan blue to aid visualization of wound leakage is, in principle, similar to the Seidel's test, which employs a strip of fluorescein, applied to the wound.Both test are positive when the dye is washed away from the wound by egress of aqueous.This technique has a few advantages over the use of fluorescence.For instance, we use trypan blue routinely for capsula staining so there is a source of trypan blue ready to be used.Secondly blue contrast shows leakage readily without use of cobalt blue light for floresence.
In conclusion, this observational series suggest that small wound leakage, especially from the side-port incision, may occur in a large number of eyes and remain asymptomatic.Although these micro leaks are of not high significance in routine cases but in case of high risk for infection as in blepharitis, surgeon should be more careful and spend more time on wound construction and sealing.Trypan blue technique based on the logic of Seidel test seems to be an effective and simple method for demonstrating unnoticed wound leakages, and

Figure 1 :
Figure 1: This intraoperative photograph reveals leakage of aques from the side port incision, visible on application of trypan blue.Clear fluid is distinctly seen streaming into a pool of trypan blue.