Corneal edema and permanent blue discoloration of a silicone intraocular lens by methylene blue

• Published in: Ophthalmic surgery, lasers & imaging Vol. 38; no. 2; p. 136
• Main Authors: Stevens, Scott, Werner, Liliana, Mamalis, Nick
• Format: Journal Article
• Language: English
• Published: United States SLACK INCORPORATED 01.03.2007
• Subjects: Capsulorhexis; Coloring Agents - adverse effects; Corneal Edema - chemically induced; Device Removal; Humans; Lens Implantation, Intraocular; Lenses, Intraocular; Male; Methylene Blue - adverse effects; Middle Aged; Phacoemulsification; Prosthesis Failure; Silicone Elastomers; Staining and Labeling
• ISSN: 1542-8877; 2325-8160; 2325-8179
• DOI: 10.3928/15428877-20070301-08

To report a silicone intraocular lens (IOL) stained blue by inadvertent intraoperative use of methylene blue instead of trypan blue and the results of experimental staining of various lens materials with different concentrations of the same dye. A "blue dye" was used to enhance visualization during capsulorhexis in a patient undergoing phacoemulsification with implantation of a three-piece silicone lens. Postoperatively, the patient presented with corneal edema and a discolored IOL. Various IOL materials were experimentally stained using methylene blue. Sixteen lenses (4 silicone, 4 hydrophobic acrylic, 4 hydrophilic acrylic, and 4 polymethylmethacrylate) were immersed in 0.5 mL of methylene blue at concentrations of 1%, 0.1%, 0.01%, and 0.001%. These lenses were grossly and microscopically evaluated for discoloration 6 and 24 hours after immersion. The corneal edema resolved within 1 month after the initial surgical procedure. After explantation, gross and microscopic analyses of the explanted silicone lens revealed that its surface and internal substance had been permanently stained blue. In the experimental study, all of the lenses except the polymethylmethacrylate lenses were permanently stained by methylene blue. The hydrophilic acrylic lenses showed the most intense blue staining in all dye concentrations. This is the first clinicopathological report of IOL discoloration due to intraocular use of methylene blue. This and other tissue dyes may be commonly found among surgical supplies in the operating room and due diligence is necessary to avoid mistaking these dyes for those commonly used during ocular surgery.