Trypan internetadvance publication at ajo.com Dec 11, 2002. Blue–assisted peeling of the internal limiting membrane during macular hole surgery

Perrier, Manuel; Sébag, Mikaël

doi:10.1016/s0002-9394(02)02239-0

Cited by 68 publications

(40 citation statements)

References 6 publications

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“…While affinity of TB to ERM is uncontroversial, our finding that it stains the ILM equally well is in accord with those who have previously advocated TB for ILM removal 33,36,37 but is at variance with others who oppose a TB affinity to acellular structures, including the ILM. 30,47 Whether TB stains the ILM directly or whether fine cellular debris overspreading the ILM is responsible 13,47 is to be elucidated in the future.…”

Section: Discussionsupporting

confidence: 87%

“…29 It displays outstanding staining of ERMs, 30,31 while evidence on its affinity to the ILM is controversial. 13,30,32,33 Trypan blue is generally recommended for the removal of epiretinal tissue rather than for ILM peeling itself, 34 although several clinical studies suggest that TB may be more useful for ILM removal than customarily conceived. [31][32][33][35][36][37] Retinal toxicity has been occasionally reported from in vitro experiments 38 and in vivo studies, 39,40 while other authors found no indications for in vivo toxicity.…”

Section: Discussionmentioning

confidence: 99%

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Quantification of Contrast Recognizability in Sequential Epiretinal Membrane Removal and Internal Limiting Membrane Peeling in Trypan Blue–assisted Macular Surgery

Henrich

Priglinger

Haritoglou

et al. 2013

Retina

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Purpose: To evaluate the selectivity and strength of intraoperative trypan blue staining during removal of epiretinal membranes (ERMs) and the internal limiting membrane.Methods: Based on intraoperative videos, 51 consecutive chromovitrectomies in 51 patients with macular holes, macular pucker, vitreomacular traction syndromes, or persistent macular edema were retrospectively studied. Fifteen subjects underwent trypan blue, 14 indocyanine green, and 22 brilliant blue G chromovitrectomy. The main outcome measure was the color contrast between stained internal limiting membrane or ERM and the underlying unstained tissue by means of objective, quantitative, semiautomated chromaticity difference measurements.Results: Trypan blue stains both ERM and the internal limiting membrane (average chromaticity scores 8.51 and 7.09, respectively; P = 0.48). Internal limiting membrane chromaticity scores were similar for trypan blue (7.09) and brilliant blue G (6.81; P = 0.71) but clearly higher for indocyanine green (15.81; P = 2.45 · 10 −5 ).Conclusion: Under the premises of our study, trypan blue stains both ERM and the internal limiting membrane. Trypan blue's staining capacity of the internal limiting membrane is similar to that of brilliant blue G but significantly inferior compared with indocyanine green. Trypan blue, thus, represents a useful vital dye for chromovitrectomy, particularly in the presence of ERM, where it allows a sequential approach.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Quantification of Contrast Recognizability in Sequential Epiretinal Membrane Removal and Internal Limiting Membrane Peeling in Trypan Blue–assisted Macular Surgery

Henrich

Priglinger

Haritoglou

et al. 2013

Retina

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“…20,28 Osmolality and pH of the Trypan blue solution Trypan blue has been used for ERM peeling and ILM peeling in concentrations varying from 0.06 to 0.2%. 5,6,[8][9][10][11][29][30][31] None of these concentrations were reported as toxic in clinical practice. Haritoglou et al 5 found visions 6 months after ERM removal to be similar between eyes operated with and without Trypan blue.…”

Section: Discussionmentioning

confidence: 99%

“…These have included the use of a slit beam illumination, triamcinolone, 1 and stains such as Indocyanine and infracyanine green (ICG), brilliant blue, 2,3 and Trypan blue. [4][5][6][7][8] Owing to a superior safety profile as compared with ICG, Trypan blue has been used by a number of European surgeons despite its lesser staining characteristics for the ILM. 7,9,10 The commercially available version of Trypan blue (MembraneBlue, DORC, Zuidland, The Netherlands) used in vitreoretinal surgery is diluted in phosphate-buffered saline.…”

Section: Introductionmentioning

confidence: 99%

Use of heavy Trypan blue in macular hole surgery

Oberstein

Smet

2010

Eye

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Purpose Intraocular dyes facilitate the identification of the inner limiting membrane (ILM) during surgery. Appropriate dyes should be safe, provide adequate staining, and be easy to use. Heavy Trypan blue eliminates the need for an air-fluid exchange (AFX) and appears to have little retinal toxicity. This study refers to a prospective, consecutive trial with heavy Trypan blue in macular hole surgery. Patients and methods A consecutive group of 20 patients with full thickness macular holes was recruited in a single institution study. Patients were operated using conventional methods. Heavy Trypan blue was prepared by mixing isovolumetrically glucose 10% with MembraneBlue (DORC, Zuidland, The Netherlands). Patients were assessed for ease of surgery and post-operatively at 3 and 6 months (vision and ocular coherence tomography) for hole closure and vision. Results Twenty eyes were included in the study. Reapplication of dye was used in 75% of the cases, leading to improved contrast further facilitating the ILM peel. In no case was an AFX necessary to obtain sufficient staining. Macular hole closure was achieved in 19 of 20 patients with one surgery. No retinal detachment or other complication was observed in the follow-up period. Conclusion Heavy Trypan blue can be delivered efficiently to the retinal surface without the need for an AFX. Staining was sufficient to help visualise and peel the ILM. Repeat applications were easily performed. The macular hole closure rate was similar to that of other series with a comparable visual improvement.

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“…TB is reported to facilitate anatomical closure of macular holes in 94-100% of eyes [72][73][74] with no significant adverse effects reported up to 1 year postoperatively. A small randomised controlled trial comparing TB with ICG 0.05% demonstrated no significant difference in visual outcome between the groups.…”

Section: Peeling Of the Ilmmentioning

confidence: 99%

Macular holes: vitreoretinal relationships and surgical approaches

Bainbridge

Herbert

Gregor

2008

Eye

100

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Idiopathic full-thickness macular holes develop as a result of anteroposterior and tangential traction exerted by the posterior vitreous cortex at the fovea. Vitreoretinal relationships during the development of macular holes can be demonstrated in detail by ocular coherence tomography, facilitating an improved understanding of their pathogenesis and guiding clinical management. Surgical strategies for the repair of macular holes are designed to relieve vitreofoveal traction and to promote flattening and reapposition of the macular hole edges by intraocular gas tamponade. A period of facedown positioning postoperatively is conventionally advised. However, the evidence to support this recommendation is weak and practice varies considerably. Surgical removal of the inner limiting membrane (ILM) is advocated to ensure thorough removal of any tangential tractional components including any residual cortical vitreous. Current evidence suggests that ILM peeling can improve anatomical outcomes but the effect on visual function is less predictable; unsuccessful attempts to peel the ILM can be associated with poor visual outcome. The use of vital dyes can facilitate visualisation of the ILM and help achieve complete, atraumatic peeling. Indocyanine green dye can enable high rates of macular hole closure but has been associated with poorer visual outcomes suggesting a dosedependent toxicity. Trypan blue dye offers an alternative that may have a more favourable risk profile. An improved understanding of vitreoretinal relationships may facilitate a tailored approach to surgery in individuals with macular holes. Vitrectomy to relieve anteroposterior traction is central in the management of all full-thickness holes. The use of long-acting gases, prolonged face-down positioning, and ILM peeling may be more valuable for larger holes, longstanding holes, and those that have failed to close following conventional surgery.

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Trypan internetadvance publication at ajo.com Dec 11, 2002. Blue–assisted peeling of the internal limiting membrane during macular hole surgery

Cited by 68 publications

References 6 publications

Quantification of Contrast Recognizability in Sequential Epiretinal Membrane Removal and Internal Limiting Membrane Peeling in Trypan Blue–assisted Macular Surgery

Quantification of Contrast Recognizability in Sequential Epiretinal Membrane Removal and Internal Limiting Membrane Peeling in Trypan Blue–assisted Macular Surgery

Use of heavy Trypan blue in macular hole surgery

Macular holes: vitreoretinal relationships and surgical approaches

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