Utilizing a 3d Model as an Alternative to Trypan Blue Staining for the Visualization of the Anterior Lens Capsule During Cataract Surgery

Objective: To assess the clinical efficacy and safety of a new technique for visualizing the anterior lens capsule (ALC) during the anterior capsulorhexis maneuver. This method utilizes a three-dimensional (3D) visualization system and does not require the use of the technically invasive trypan blue (TB) dye staining. Methods: The study population was divided into two groups: the main group (MG) and the control group (CG). The MG consisted of 250 patients who underwent cataract surgery using a 3D visualization system. This system employs black-and-white filters and reduced color saturation to improve visibility during capsulorhexis. In contrast, in the CG, which also consisted of 250 patients, conventional microscope imaging with TB dye (0.05%) staining for ALC visualization was utilized. Results: The patients in the MG and the CG exhibited a low rate of intraoperative and postoperative complications, with only 8 cases out of 500 eyes operated, resulting in a complication rate of 1.6%. There were no statistically significant differences between the MG and CG regarding best-corrected visual acuity (BCVA) and uncorrected visual acuity (UCVA) (p>0.05). The average surgical time was 10.2 minutes for the MG and 11.1 minutes for the CG (p>0.05). However, there was a statistically significant increase in the capsulorhexis time in the MG (p<0.05), as well as in the intraocular lens (IOL) implantation time in the CG (p<0.05). Additionally, significantly lower light intensity was used in the operating microscope for the MG, averaging 17.2%, compared to 47.9% for the CG (p<0.05). In the MG, there was a significantly lower incidence of the capsulorhexis radial tear at 0.8% of patients, compared to 4.0% in the CG (p<0.05). The peripheral runaway capsulorhexis was observed in 0.4% of patients in the MG, while it occurred in 1.6% of patients in the CG (p>0.05).Conclusion: The visualization of the ALC using a 3D system and black-and-white filters is currently of interest for cataract surgery, serving as an alternative to the standard visualization method that employs TB dye.