RESUMO
ANTECEDENTES: Las tinciones capsulares constituyen uno de los mayores avances en la cirugía oftálmica al permitir la tinción de la cápsula anterior del cristalino en las cirugías de catarata. El azul de tripán se utiliza en los casos en los que no se visualiza de forma adecuada la cápsula anterior del cristalino cuando el reflejo rojo es pobre o nulo. Diferentes estudios señalan que el azul de tripán es un colorante eficaz y seguro para la tinción de la cápsula anterior del cristalino. METODOLOGIA: En la presente revisión se evaluó las diferencias en la efectividad entre las distintas concentraciones del azul del tripán. RESULTADOS: Los resultados muestran que el azul de tripán es una coloración segura y útil para la tinción de la cápsula anterior del cristalino. CONCLUSION: El azul de tripán tiene una amplia ventana terapéutica que permite ser utilizado a distintas concentraciones (0.0125%, 0.06%, 0.1%, 0.4% y 0.6%). Sin embargo, un estudio indicó que la concentración efectiva más baja para teñir el cristalino fue la de 0.1%.
Assuntos
Humanos , Extração de Catarata/métodos , Cápsula do Cristalino/efeitos dos fármacos , Azul Tripano/administração & dosagem , Análise Custo-Benefício , Avaliação da Tecnologia BiomédicaRESUMO
PURPOSE: To evaluate the ultrastructural effect of trypan blue 0.1% staining for capsulorhexis on lens epithelial cells (LECs) and capsules. SETTING: Division of Ophthalmology, University of São Paulo, São Paulo, Brazil. METHODS: Before capsulorhexis, patients were randomly assigned to 1 of 2 groups. Trypan blue 0.1% staining was performed in the treatment group. No trypan blue was used in the control group. Samples of capsules with LECs were fixed and analyzed with routine optical microscopy techniques, immunohistochemistry for beclin-1 expression (a marker of autophagy), terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling to detect apoptosis, and transmission electron microscopy (TEM). Morphometric analyses were performed, and the 2 sets of data were compared. RESULTS: Each group comprised 15 patients. Cell death by autophagy and apoptosis was observed in the treatment group but not in the control group. The TEM images of subcapsular epithelium cells showed mitochondrial rupture, dilation of the cisterns of the endoplasmic reticulum, increased cytoplasmic and nuclear electron density, and abnormalities in the nuclear profile of trypan blue-stained cells. Morphometric analysis showed statistically significant differences between the 2 groups in the longest nuclear axes and the ratio between the total nuclear perimeter and the cell area (P = .03). The difference in capsule thickness between groups was not significant. CONCLUSION: Trypan blue caused LEC death, which supports the hypothesis that staining with trypan blue 0.1% can help reduce the incidence of posterior capsule opacification after cataract surgery. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.
Assuntos
Capsulorrexe , Corantes/farmacologia , Cápsula do Cristalino/ultraestrutura , Cristalino/ultraestrutura , Azul Tripano/farmacologia , Apoptose/efeitos dos fármacos , Proteínas Reguladoras de Apoptose/metabolismo , Proteína Beclina-1 , Fragmentação do DNA , Células Epiteliais/efeitos dos fármacos , Células Epiteliais/metabolismo , Células Epiteliais/ultraestrutura , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Marcação In Situ das Extremidades Cortadas , Cápsula do Cristalino/efeitos dos fármacos , Cristalino/efeitos dos fármacos , Cristalino/metabolismo , Proteínas de Membrana/metabolismo , Microscopia Eletrônica de Transmissão , Microscopia de Fluorescência , Facoemulsificação , Estudos Prospectivos , Coloração e RotulagemRESUMO
PURPOSE: To evaluate the ability of novel dyes to stain lens capsule (LC), internal limiting membrane (ILM), epiretinal membrane (ERM), and vitreous. DESIGN: Experimental study in animal and human donor eyes. METHODS: Thirteen dyes, methyl violet, crystal violet, eosin Y, sudan black B, methylene blue, toluidine blue, light green, indigo carmine, fast green, congo red, evans blue, brilliant blue, and bromophenol blue, were injected onto the LC and ILM of enucleated porcine eyes. The vitreous was stained with 2 mL of dyes for 1 minute. Six dyes (indigo carmine, evans blue, fast green, light green, bromophenol blue, and brilliant blue) were selected for experiments in human donor eyes and freshly removed ERM. RESULTS: In the porcine eyes, ILM staining with methylene blue, toluidine blue, indigo carmine, evans blue, bromophenol blue, and fast green was moderate, and methyl violet, crystal violet, brilliant blue, or sudan black resulted in strong staining. Methyl violet, crystal violet, sudan black, toluidine blue, and methylene blue caused histologic damage in porcine retinas. Vitreous examination revealed moderate staining with congo red, crystal violet, fast green, eosin Y, methylene blue, toluidine blue, brilliant blue, bromophenol blue, and methyl violet and strong staining with light green and evans blue. ERMs showed strong staining with 0.5% evans blue and moderate staining with 0.5% light green, fast green, brilliant blue, and bromophenol blue. Evaluation of donor eyes disclosed moderate staining with evans blue, light green, and bromophenol blue and strong staining with 0.5% brilliant blue. Moderate or strong staining of the vitreous occurred with most dyes. LC evaluation showed moderate staining with 0.5% evans blue, fast green, and brilliant blue, whereas 0.5% light green produced strong LC staining. CONCLUSIONS: Brilliant blue shows the best ILM staining, whereas bromophenol blue, evans blue, and light green also stain ILM. Most dyes bind well to LC, vitreous, and ERM.