Alabbasi Omar, Alahmadi Mubarak W, Alsaedi Mohammed G, AlShammari Ali Zain Abden M
Ophthalmology: Anterior Segment, King Salman Medical City, Madinah, SAU.
Ophthalmology, Ohud Hospital, Madinah, SAU.
Cureus. 2025 May 20;17(5):e84448. doi: 10.7759/cureus.84448. eCollection 2025 May.
An intracameral injection of methylene blue 1% during cataract surgery induces extreme cytotoxicity, primarily affecting the corneal endothelium and iris epithelium. This case series illustrates the clinical presentation, management, and outcomes of three patients who underwent cataract surgery, with unintended exposure to methylene blue. All patients demonstrated early-onset corneal edema and anterior segment inflammation shortly after surgery. Two patients developed severe, irreversible endothelial decompensation, leading to persistent corneal edema, decreased visual acuity, and eventual need for Descemet's stripping endothelial keratoplasty (DSEK). In contrast, the third patient experienced transient corneal edema, which gradually resolved with medical therapy, resulting in significant, though incomplete, visual recovery. No intraocular pressure spikes or retinal toxicity were noted. In conclusion, methylene blue is highly cytotoxic to intraocular structures, particularly the corneal endothelium and iris epithelium. Accidental administration can cause serious and irreversible visual impairment. Vigilant dye verification protocols, enhanced labeling systems, and multidisciplinary checks are critical in preventing such adverse events. Surgeons must remain cautious and ensure that only approved agents are utilized for anterior capsule staining during cataract surgery.
白内障手术期间前房内注射1%亚甲蓝会引发极强的细胞毒性，主要影响角膜内皮和虹膜上皮。本病例系列阐述了3例白内障手术中意外接触亚甲蓝患者的临床表现、处理及预后。所有患者术后不久均出现早期角膜水肿和前段炎症。2例患者发生严重、不可逆的内皮失代偿，导致持续性角膜水肿、视力下降，最终需要进行后弹力层剥脱内皮角膜移植术（DSEK）。相比之下，第3例患者经历了短暂的角膜水肿，经药物治疗后逐渐消退，视力虽未完全恢复，但有显著改善。未观察到眼压峰值或视网膜毒性。总之，亚甲蓝对眼内结构具有高度细胞毒性，尤其是角膜内皮和虹膜上皮。意外给药可导致严重且不可逆的视力损害。警惕的染料核查方案、强化的标签系统以及多学科检查对于预防此类不良事件至关重要。手术医生必须保持谨慎，确保白内障手术期间仅使用经批准的药物进行前囊染色。
