Inner retinal thinning after Brilliant Blue G-assisted internal limiting membrane peeling for vitreoretinal interface disorders

Abstract

The aim of this study was to evaluate ganglion cell layer and nerve fiber layer thickness after Brilliant Blue G (BBG)-assisted internal limiting membrane (ILM) peeling for vitreomacular disorders. Retrospective analysis of spectral domain optical coherence tomography (SD-OCT) of 42 eyes of 42 patients, who underwent pars plana vitrectomy with BBG-assisted ILM peeling, was performed. Inclusion criteria were idiopathic macular hole, idiopathic vitreomacular traction, and idiopathic epiretinal membrane. Key exclusion criteria were vitreoretinal interface abnormalities secondary to any other diseases, follow-up period of less than 3 months, and any other associated retinal pathology. Average, minimum, and sectoral ganglion cell, and inner plexiform layers (GCIPL) and retinal nerve fiber layer (RNFL) parameters were collected. Changes in these parameters from baseline to 3- and 6-month visits after surgery were analyzed. At 3 months after surgery, we found a statistically significant reduction in the average GCIPL thickness (P = 0.031) and also in the superior sectors (P < 0.05) compared to the baseline values. A similar reduction was observed in the minimum RNFL thickness (P = 0.028) as well as in the superior sectoral RNFL thickness (P < 0.05). In 14 eyes with 6 months of follow-up, a similar statistically significant thinning of the GCIPL and RNFL was observed. However, the difference between the 3-month and 6-month values was not statistically significant (P = 0.679). BBG-assisted ILM peeling for vitreomacular interface disorders leads to thinning of the inner retina including GCIPL and RNFL. These structural changes should be correlated with retinal function tests to explore the pros and cons of this surgical step.

Infracyanine Green vs. Brilliant Blue G in Inverted Flap Surgery for Large Macular Holes: A Long-Term Swept-Source OCT Analysis

“…The substantial equivalence of the two groups with regard to the parafoveal macular area thickness (MT), which includes all the neural retina layers, and the inner 3-mm parafoveal area including ILM, GCL++ seems to deny difference in toxicity from the two dyes by SS-OCT evaluation at this level. The thinning of the outer 6-mm GCL++ area from 6 to 12 months in all sectors in both groups is in agreement with literature data, since, as described in the introduction, thinning of the inner retina, including GCL++ and RNFL, after ILM peeling has been described both with ICG and BBG in SD-OCT-based studies [24,[30][31][32][33]. In our patients, we must at first note that in the majority of cases, as described in the surgical procedure section, ILM surgical manipulation began near the inferior or superior vascular arcade.…”

“…Optical coherence tomography (OCT) analysis of central foveal thickness (CFT) and length of the defect of the photoreceptor inner segment/outer segment junction (IS/OS) indicate better outcomes with BBG than ICG in traditional FTMH surgery [29]. However, some experimental and clinical studies indicate a degree of toxicity from blue dyes in vitreoretinal interface and traditional macular hole surgery [24,[30][31][32]. Studies using spectral-domain (SD) OCT analysis point out postoperative thinning of the inner retinal layers after BBG-stained ILM peeling, mainly of the temporal macular ganglion cell and inner plexiform layer (GCL++) [30][31][32][33].…”

“…However, some experimental and clinical studies indicate a degree of toxicity from blue dyes in vitreoretinal interface and traditional macular hole surgery [24,[30][31][32]. Studies using spectral-domain (SD) OCT analysis point out postoperative thinning of the inner retinal layers after BBG-stained ILM peeling, mainly of the temporal macular ganglion cell and inner plexiform layer (GCL++) [30][31][32][33]. This seems indeed related surgical trauma and/or temporal thinning resulting from post-surgical nasal displacement of the fovea, without agreement on the influence of blue dye toxicity [32,33].…”

Evaluation of Ganglion Cell-Inner Plexiform Layer Thickness after Vitreoretinal Surgery with Internal Limiting Membrane Peeling in Cases with Idiopathic Macular Hole

“…In another study including 42 eyes, significant decreases were observed in mean GCIPL thickness and superior sector GCIPL thickness at postoperative 3 and 6 months after ILM peeling with brilliant blue G compared to baseline values, and it was found that this thinning was also accompanied by RNFL thinning. 37 …”

Different Surgical Techniques on Internal Limiting Membrane For The Treatment of Idiopathic Macular Hole

“…İnsan pigment epitel hücrelerinde elektrofizyolojik değerlendirmeler 5 dakikalık boya uygulaması ile retina gangliyon hücreleri üzerinde toksik etki olmadığını göstermiştir. [52] Retrospektif karşılaştırmalı bir vaka serisinde Membran Blue Dual ile başarılı cerrahi sonuçlar bildirilmiştir. [53] İç Limitan Membrana Yönelik Farklı Cerrahi Yöntemler İLM soyulmasının klinik sonuçları tam bilinmemekle beraber, takipler sırasında progresif optik sinir lifi tabakası ayrışması, papillomaküler mesafede kısalma ve makulanın asimetrik yer değiştirmesi gibi anatomik değişiklikler kaydedilmiştir.…”