Staining of the Internal Limiting Membrane with the Use of Heavy Brilliant Blue G (original) (raw)
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Indian Journal of Ophthalmology, 2012
Context: Surgical outcomes of vitrectomy for idiopathic macular hole using a "heavy" Brilliant Blue G (HBBG) solution for staining and removal of the internal limiting membrane (ILM). Settings and Design: Prospective interventional case series conducted in a tertiary eye care hospital. Materials and Methods: Nineteen patients (20 eyes) with idiopathic macular hole were enrolled to undergo vitrectomy with ILM peeling using HBBG. BBG dye was made heavy by mixing with 10% dextrose normal saline (DNS) solution in 2:1 ratio. The adequacy of ILM staining was noted intraoperatively. The closure rates of macular hole and visual improvement were recorded. Patients were followed up postoperatively on day 1, week 1, and subsequently at 1, 3, and 6 months, and every 6th month thereafter. Statistical Analysis: Wilcoxon signed-rank test was used; P < 0.05 was considered significant. Results: Preoperative best-corrected visual acuity (BCVA) ranged from 20/1000 to 20/63 (median: 20/100). Intraoperatively, the ILM stained very well in all eyes, and was easily removed. All macular holes closed postoperatively. The mean follow-up was 6.15 ± 2 months (range: 4-10; median: 6 months). Final BCVA ranged from 20/20 to 20/80 (median: 20/40), amounting to a significant visual improvement (P = 0.0001). BCVA improved by 1-8 Snellen lines in 19 eyes (95%); 16 eyes (80%) improved by ≥2 lines; 13 eyes (65%) achieved a final BCVA of 20/40 or better. Conclusions: Addition of 10% DNS to BBG dye allowed good ILM staining with less dye during macular hole surgery, and provided excellent anatomic and visual outcomes.
British Journal of Ophthalmology, 2010
Purpose. To assess the selectivity of brilliant blue G (BBG) staining by analysing the 28 morphologic components of unstained and stained tissue obtained during epiretinal 29 membrane (ERM) removal with internal limiting membrane (ILM) peeling in BBG-30 assisted macular surgery. 31 Methods. Twenty-six surgical specimens were removed from 13 eyes with epiretinal 32 gliosis during vitrectomy using BBG for ERM and ILM peeling. We included eyes with 33 idiopathic macular pucker, idiopathic macular hole, and vitreomacular traction 34 syndrome. The dye was injected into the fluid filled globe. Unstained and stained 35 epiretinal tissue was harvested consecutively and placed into separate containers. All 36 specimens were processed for conventional transmission electron microscopy. 37 Results. The first surgical specimen of all eyes showed no intraoperative staining 38 with BBG and corresponded to masses of cells and collagen. The second surgical 39 specimen demonstrated good staining characteristics and corresponded to the ILM in 40 all patients included. In seven eyes, the ILM specimens were seen with minor cell 41 proliferations such as single cells or a monolayer of cells. Myofibroblasts, fibroblasts 42 and astrocytes were present. In five cases, native vitreous collagen fibrils were found 43 at the ILM. In six of all eyes, ILM specimens were blank. 44 Conclusion. Our clinicopathologic correlation underlines the selective staining 45
British Journal of Ophthalmology, 2003
Aims: To report on the use of trypan blue (TB) 0.06% for staining the internal limiting membrane (ILM) and epiretinal membrane (ERM) during vitrectomy and report on their histology. Method: 14 consecutive patients with idiopathic macular hole or macular pucker (seven patients each) were prospectively recruited for ILM or ERM peel respectively. After pars plana vitrectomy and induction of posterior vitreous detachment, 0.5 ml TB 0.06% in phosphate buffered saline (VisonBlue) was injected over the posterior pole in an air filled eye and left for 2 minutes. The stained tissue was peeled with intraocular forceps. Specimens were evaluated using histochemical and immunohistochemical methods. Results: The average follow up was 4.4 months. Internal limiting membranes and epiretinal membranes were stained satisfactorily in all cases and removed successfully. Eight patients (57%) had improvement of 2 or more Snellen lines. All seven macular holes closed. In the ERM cases, no residual membranes were observed clinically, at the latest follow up. No complications relating to the use of the dye were encountered intraoperatively or postoperatively. Of the 14 procedures, nine (four macular hole and five macular pucker) yielded sufficient tissue for histopathological evaluation. Histological and immunohistological assessment revealed that the morphology of these specimens was similar to that observed in macular hole ILM and macular pucker ERM removed without the aid of dye. Conclusion: TB staining facilitated the identification and delineation of ILM and ERM removal during the surgical management of macular holes and macular pucker. The visual outcome of this series and the specimens removed suggest they are no different from those without TB staining. Its use in posterior segment appears to be safe but further studies are required to investigate its long term safety.
Brilliant blue G-assisted peeling of the internal limiting membrane in macular hole surgery
Indian Journal of Ophthalmology, 2011
Dye-assisted internal limiting membrane (ILM) peeling and gas tamponade is the surgery of choice for idiopathic macular holes. Indocyanine green and trypan blue have been extensively used to stain the ILM. However, the retinal toxicity of indocyanine green and non-uniform staining with trypan blue has necessitated development of newer vital dyes. Brilliant blue G has recently been introduced as one such dye with adequate ILM staining and no reported retinal toxicity. We performed a 23-gauge pars plana vitrectomy with brilliant blue G-assisted ILM peeling in six patients with idiopathic macular holes, to assess the staining characteristics and short-term adverse effects of this dye. Adequate staining assisted in the complete removal of ILM and closure of macular holes in all cases. There was no evidence of intraoperative or postoperative dye-related toxicity. Brilliant blue G appears to be safe dye for ILM staining in macular hole surgery.
American Journal of Ophthalmology, 2004
To evaluate the effect of indocyanine green (ICG) diluted with glucose 5% on the human retina in an experimental setting in postmortem eyes and during surgery for macular hole formation. Histopathological evaluation. Possible adverse effects of two different solutions of 0.05% ICG (Pulsion, Munich, Germany; and Infracyanine, Laboratoire SERB, Paris, France) diluted with glucose 5% were evaluated in four eyes of two donors. In one eye of each donor, the ICG-stained macula was illuminated with 380 to 760 nm using the light source of a commonly used vitrectomy machine. In the other eye, ICG was applied to the macula without illumination. The retinal specimens were evaluated using light- and electron microscopy. Additionally, the ultrastructure of the internal limiting membrane (ILM) of four eyes that underwent ICG-assisted vitrectomy for macular hole formation was examined. In the postmortem study, both solutions of ICG caused significant morphologic alterations of the inner retina after light exposure. There was disorganization of the inner retina and complete loss of ILM after application of the dye and illumination. In contrast, no abnormalities were found after application of the dye without illumination and in unstained control specimens. No differences were noted between the two ICG products. Specimens of the ILM harvested during vitrectomy revealed cellular elements adjacent to the retinal side of the ILM. Staining of the ILM using ICG diluted in glucose 5% followed by illumination might induce an adverse effect on the inner retina and may result in an alteration of the cleavage plane from the ILM to the innermost retinal layers.
Anatomical and functional outcome in brilliant blue G assisted chromovitrectomy
Acta Ophthalmologica, 2009
Purpose: To evaluate the potential of brilliant blue G (BBG) for intraoperative staining of the inner limiting membrane (ILM) with respect to staining properties and surgical outcome. Methods: In a retrospective, non-comparative clinical case series, we analysed 17 consecutive chromovitrectomy interventions for surgery of macular holes, ERMs, vitreoretinal traction syndromes and cystoid macular oedema. Following complete posterior vitreous detachment, BBG was injected into the vitreous cavity at a concentration of 0.25 mg ⁄ ml, followed by immediate washout. Main outcome measures were staining properties, visual acuity, central visual field testing and optical coherence tomography (OCT) measurements over a mean follow-up period of 3 months. Results: ILM staining was somewhat less intensive for BBG than for average indocyanine green (ICG) chromovitrectomy. However, the ILM was removed successfully without additional ICG in 15 ⁄ 17 patients. Postoperative visual acuity was improved in 16 ⁄ 17 patients and remained unchanged in one patient. Central retinal OCT thickness showed a postoperative reduction, with values ranging from +7 to )295 lm (median )89 lm). Neither visual field defects nor any other adverse events were recorded. Conclusion: BBG permits sufficient staining for safe ILM removal. In this short-term study, good anatomical and functional results were achieved and no adverse events were observed.
Heavy trypan blue staining of epiretinal membranes: an alternative to infracyanine green
British Journal of Ophthalmology, 2007
Background: By using dyes, it is easier to identify the extent of an epiretinal membrane (ERM) or the inner limiting membrane (ILM) during surgery. Trypan blue (TB) stains ERM and ILM weakly, but with less apparent toxicity than other intraocular dyes. Its main drawback in vitreoretinal surgery is the requirement of an airfluid exchange (AFX) before its use. Aim: To propose a modified form of TB denser than water, thus obviating the need for an AFX. Design: A prospective, consecutive trial with heavy trypan blue in vitreoretinal surgery. Methods: A consecutive group of patients with ERMs was recruited prospectively. Patients were operated on using conventional methods. Heavy TB was prepared by mixing glucose 10% with Membrane blue (Dorc, Zuidland, The Netherlands) isovolumetrically. Patients were preoperatively and postoperatively assessed at 3 and 6 months (vision and ocular coherence tomography (OCT)). Ease of surgery was also assessed. Results: 29 eyes were included in the study. Reapplication of dye was necessary in 25% of the cases, leading to improved contrast further facilitating the peeling process. In no case was an AFX necessary to obtain sufficient staining. All patients with ERM had an improvement in vision (from median 0.30 to 0.55) and macular volume and foveal thickness (from median 450 to 238 mm) on OCT. No retinal detachment or other complications developed as a result of surgery. Conclusion: Heavy TB can be delivered efficiently to the retinal surface without an AFX. Staining was sufficient to allow a safe and efficient peeling of ERM. Repeat applications were easily performed. Its use was associated with vision improvement and decreased in foveal thickness, and the absence of adverse events in this small case series.