This patient had a prior episode of anterior segment inflammation which caused synechiae to develop, with adhesion of the iris to the anterior lens capsule. This prevented full dilation and in order to perform cataract surgery, these synechiae need to be released. Pupil stretching was done in addition to the lysis of synechiae in order to expand the pupil further.
One of the challenges is staining the anterior lens capsule with typan blue dye, which does not stick as well if there is dispersive viscoelastic coating the capsular surface. One approach is to inject viscoelastic and break the synechiae, then aspirate out the viscoelastic in order to stain the capsule. This works, but wastes viscoelastic, which can be costly.
Our approach is to place small drops of trypan blue dye under the iris to stain the capsule, prior to filling the anterior chamber with dispersive viscoelastic.
Click below to learn this technique and see lysis synechiae: