Introduction. The aim of this study was to report pathological analyses of a hydrophilic acrylic intraocular lens (IOL) with high water content (73.5%) explanted because of staining with trypan blue.

Material and Methods. A 79-year-old Caucasian male patient underwent cataract surgery OD with implantation of an Acqua lens. Trypan blue (0.1%) was used during the surgical procedure to stain the anterior capsule and enhance the contrast while performing capsulorhexis. Seven days after surgery, the patient presented with “dark and double” vision. The IOL was decentered superiorly and appeared dark blue. The lens was explanted 2 months after surgery; gross and microscopic analyses were performed in a dry state and after hydration.

Results. Analyses of the explanted lens revealed that the dark blue staining was denser within the optic component, especially in the optical periphery.

The blue discoloration could not be removed after 24 hours of immersion of the lens in balanced salt solution at 37ºC.

Discussion. It is important to investigate whether “staining” is only observed with lenses manufactured from biomaterials having very high water contents, or might be observed in association with hydrophilic acrylic lenses in general. Also, the staining is eventually associated only with hydrophilic acrylic lenses implanted in the dry state, which will depend on the fluids within the capsular bag for complete hydration/expansion.

Conclusion. The Acqua lens should not be implanted when capsular dyes were used intraoperatively to enhance visualization of the capsule during capsulorhexis.