Visual rehabilitation in eyes with cataract and coexisting corneal opacity can be best performed by a corneal triple procedure (combined penetrating keratoplasty with cataract surgery). However, factors like graft rejection and infection may jeopardize the outcome of penetrating keratoplasty. This may be of special relevance in developing countries like India, where there is a long waiting period for keratoplasty because of paucity of good-quality donor material. Moreover, the consequences of graft failure can be grave in one-eyed individuals who have lost vision in the other eye due to an irreversible ocular pathology. In these patients, particularly if the corneal opacity is vascularized, cataract extraction with intraocular lens implantation may provide a suboptimal but long-term vision. However, cataract extraction is difficult in these eyes because of poor visibility through the corneal opacity.

We used trypan blue dye to stain the anterior capsule to enhance visualization during surgery. Trypan blue is commonly used to stain the anterior capsule in order to enhance visualization for capsulorhexis in white cataracts.1, 2 This dye has been considered safe for intraoperative use as it has been used clinically to examine endothelial cell damage after cataract extraction3 and is also used to examine endothelium of donor corneoscleral button before corneal transplantation.4 In eyes with cataract and coexisting corneal opacities, trypan blue has been used successfully to enhance visualization to perform phacoemulsification.5

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