State of the art in chromovitrectomy

Abstract

Vitrectomy is a surgery that involves complex and delicate techniques that treat diseases such as macular hole, epiretinal membrane and diabetic macular edema. Chromovitrectomy is one of these techniques and includes the use of coloring agents such as vital dyes or crystals to enhanced visibility of transparent structures during vitrectomy. The aim of this study was to present a modern approach, based on scientific evidence, about the application and indication of vital coloring agents during vitrectomy. The use of such agents has made this surgery more predictable and has increased its post-operative prognosis. Although research on chromovitrectomy is currently expanding there is still not an established gold standard dyeing agent.Keywords: Vitrectomy; Vitreous body; Macular hole; Retina; Dyeing agents; Epiretinal membrane RESUMOA cirurgia vitreorretiniana é uma cirurgia que envolve técnicas complexas e delicadas que tratam doenças como buraco macular, membrana epirretiniana e o edema macular diabético. A cromovitrectomia é uma dessas técnicas que incluem o uso de corantes compostos de pigmentos vitais ou cristais para melhorar a visibilização de estruturas transparentes durante a cirurgia de vitrectomia. O objetivo desse artigo foi apresentar uma abordagem atual, baseada em evidências, sobre a aplicação e indicação de corantes vitais durante a cirurgia vitreorretiniana. O emprego desses corantes possibilitou uma maior previsibilidade para a cirurgia, melhorando assim seu prognóstico pós-operatório. Apesar do campo da cromovitrectomia está em plena expansão de pesquisas, um corante gold standard para cromovitrectomia ainda não está estabelecido.

Advances in Vitreoretinal Surgery

“…A failure to properly visualize structures can cause inaccurate movements and irreversible damage to structures that are fundamental to vision. Chromovitrectomy was developed about two decades ago to minimize the risks during the stages [ 21 ].…”

“…Trypan blue was initially used in 2000 to dye the anterior capsule during cataract surgery and donor endothelial cells in endothelial corneal transplantation, and it was later for evaluated chromovitrectomy [ 27 ]. Trypan blue has an affinity for tissues with high cellular proliferation, such as epiretinal membranes (ERMs), and it is less effective for staining the ILM compared with ICG [ 21 ]. Toxicity is minimal when used in low concentrations.…”

Optical coherence tomography angiography using the black-and-white pixel binarization histogram software: a new technique for evaluating healing of macular holes in two surgical techniques

“…The state-of-the-art surgery for MH repair typically consists of PPV, separation, and removal of the posterior vitreous cortex, removal of the ILM, filling of the vitreous cavity with gas or air, and postoperative facedown positioning [4]. To aid the ILM peeling, numerous dyes are currently available such as indocyanine green, infracyanine green, lutein-based dyes and brilliant blue (BB); the last is used most frequently worldwide for ILM staining due to its high affinity for this retinal structure and its excellent safety profile when used at the concentration of 0.25 mg/ml [7].…”