Safety and effectiveness of vital dyes for intraocular surgery

Over the last decade, vital dyes have revolutionized ophthalmic surgery, becoming indispensable tools in many intraocular procedures. These intraocular medical devices enhance visualization, facilitate tissue differentiation and improve surgical precision, ultimately optimizing outcomes. An understanding of their physicochemical properties and staining patterns is crucial for maximizing their benefits and achieving near-histological accuracy. In the recent years, increasing attention has been given to the biocompatibility of intraocular devices to enhance safety and minimise risks. Despite their widespread use, the long-term safety, interactions with intraocular devices, and optimal staining protocols of vital dyes remain insufficiently understood. Addressing these gaps is critical to improving surgical efficacy and patient safety. This review synthesizes recent findings to bridge these knowledge gaps and provide updated clinical insights, offering a comprehensive and detailed analysis of the physicochemical properties, staining mechanisms, and safety profiles of both traditional and newly developed vital dyes. Additionally, it examines how these properties influence surgical efficacy and biocompatibility. We also present an in-depth overview of experimental and clinical studies investigating the potential intraocular toxicity of vital dyes, focusing on crucial and controversial topics, such as surgical risk factors, the interaction between intraocular medical devices and the role of phototoxicity. Drawing on the latest experimental and clinical evidence, we propose updated guidelines to optimise the safe and effective use of vital dyes in intraocular surgery and patients outcomes.