Color-Contrast Adjustment With a 3D Head-Up System to Aid Capsulorhexis After ICG Staining: Single-Patient Case Report From a Tertiary Center

We report a single case in which continuous curvilinear capsulorhexis (CCC) was safely completed using NGENUITY in 3D head-up surgery (HUS) during cataract surgery. Visibility of the dye-stained anterior capsule was improved during the CCC procedure. An 84-year-old female underwent a planned extracapsular extraction on December 2022, in HUS using NGENUITY for a Grade 4 cataract classified by the Emery–Little classification. After staining the anterior capsule with 0.5% indocyanine green (ICG) for 5 s, the anterior chamber was washed to reduce the risk of endothelial damage. Then, CCC was performed by adding red enhancement to a monochrome-filtered image using the color contrast adjustment function of NGENUITY. The contrast of the anterior capsulotomy margin appeared sharper than in the normal setting, which enhanced the visibility of the capsulotomy margin of the anterior lens capsule. This allowed CCC to be completed smoothly and safely. Subsequently, the surgery was performed as usual and the intraocular lens (IOL) was fixed in the capsular bag to complete the procedure. One month after surgery, the fixation and position of the IOL were stable. Color channel adjustment in a 3D head-up system improved the visibility of CCC margins after ICG staining in advanced nuclear cataracts. This technique may be useful in cases with a poor red reflex. Future prospective studies using objective contrast evaluation are needed.