Methylthioninium chloride
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Eye disorders following inadvertent administration: case report A 60-year-old woman developed iris pigment dispersion and severe decompensation of her corneal epithelium after inadvertently receiving methylthioninium chloride for anterior lens capsule staining during phacoemulsification cataract surgery. The woman, whose best corrected preoperative visual acuity was 20/40 OS and 20/100 OD, inadvertently received methylthioninium chloride 1% [dosage not stated] instead of trypan blue 0.025%; methylthioninium chloride was injected in her anterior chamber using ‘bubble’ technique. Once the error was identified , the woman received copious irrigation with balanced salt solution. During the surgery, excessive iris pigment dispersion was noted [time to reaction onset not stated]. On postoperative day 1, she had developed severe corneal oedema and her visual acuity had decreased to 20/150 OD. Her intraocular pressure was 16mm Hg and she had extensive iris discolouration. She started receiving dexamethasone and chloramphenicol eye drops. After 4 months, her iris discolouration had persisted, her visual acuity had not improved, and her cornea remained oedematous. Over the next 12 months, her visual acuity decreased to 20/200 and her cornea developed bullous keratopathy. Diffuse iris discolouration was still evident and she had dispersed pigment on the anterior surface of her intraocular lens and her corneal endothelium. After 16 months postsurgery, she underwent a penetrating keratoplasty. Histological examination of her corneal button showed corneal oedema with no corneal endothelial cells. After 9 months, her corneal graft remained clear and her visual acuity was 20/40 OD. Author comment: "[T]he almost total destruction of the corneal endothelium may have resulted from direct cytotoxicity or loosening of endothelial adherence to the Descemet membrane. . . This case reports documents the extreme toxicity of [methylthioninium chloride] 1% on anterior chamber structures, especially iris pigment epithelium and corneal endothelium." Brouzas D, et al. Severe toxic effect of methylene blue 1% on iris epithelium and 801043251 corneal endothelium. Cornea 25: 470-471, No. 4, May 2006 - Greece
0114-9954/10/1116-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 26 Aug 2006 No. 1116
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