Effect of Trypan Blue on Corneal Endothelial Cell Count During Phacoemulsification

Age-related cataract is one of the leading causes of reversible visual impairment worldwide. Trypan blue is commonly used during phacoemulsification to stain the anterior lens capsule, particularly in mature or dense cataracts, to facilitate continuous curvilinear capsulorhexis. Although trypan blue improves intraoperative visualization, concerns remain regarding its potential effect on the corneal endothelium.

This single-center, parallel-group, randomized controlled trial was conducted at the Department of Ophthalmology, Hayatabad Medical Complex, Peshawar, Pakistan. Sixty patients aged 45 to 75 years with age-related cataract scheduled for phacoemulsification were randomly allocated in a 1:1 ratio to undergo phacoemulsification either with trypan blue-assisted anterior capsule staining or without trypan blue. All procedures were performed using a standardized surgical technique by the same surgical team.

The primary outcome was postoperative corneal endothelial cell count measured by specular microscopy. The study compared postoperative endothelial cell counts and endothelial cell loss between the two treatment groups to evaluate the effect of trypan blue on corneal endothelial safety during phacoemulsification.

Inclusion criteria

• Adults aged 45 to 75 years.
• Diagnosed with age-related cataract.
• Scheduled to undergo phacoemulsification with posterior chamber intraocular lens implantation.
• Able and willing to provide written informed consent.

Exclusion criteria

• Diabetes mellitus.
• Glaucoma.
• Previous ocular surgery.
• Corneal opacity.
• Pre-existing corneal endothelial disease.
• Uveitis.
• Traumatic cataract.
• Complicated cataract.
• Any other ocular pathology that could affect corneal endothelial cell count or interfere with study outcomes.