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Impressum
In-vivo staining of epiretinal membranes and the internal limiting membrane with trypane blue
1Mohr A., 2Melles G.
1Augenklinik St. Joseph-Stift GmbH , Schwachhauser Heerstraße 54,
D - 28209 Bremen;
2Netherlands Institute for Innovative Ocular Surgery, Maaskantstraat 31,
NL 3071 - MJ Rotterdam
Introduction: For identification of delicate epiretinal membranes,
especially the internal limiting membrane, an intravitreal application
of dye may avoid iatrogenic retinal damage during surgery. We investigated
for the first time if the vital dye trypane blue, which is already used
in corneal eye banking and mature cataract surgery, is also useful in
macular surgery.
Patients and Methods: After obtaining informed consent, 4 eyes
of 4 patients had in vivo staining. Two eyes had a glittering fine membrane,
one had a macular hole stage 2a, and one had a proliferative tractional
membrane from a diabetes type I. After a careful vitrectomy with delamination
of the posterior hyaloid a fluid-air exchange was performed followed by
injection of 0.1 ml trypane blue 0.3%. One minute after the injection
all excess dye was removed by continued air flow. To determine the staining
effect the vitreous cavity was refilled with BSS - solution.
Results: In all eyes, epiretinal structures over the posterior
pole stained blue-grey. The staining effect diminshed during the surgery
and disappeared completely within 10 minutes. During this time epiretinal
structures could be clearly identified and removed safely. No detectable
staining of the nerve fiber layer was observed. The internal limiting
membrane stained as well as other membranes. Intensive staining was found
in the diabetic tractional membrane, allowing better dissection from underlying
neuroretina. At the first postoperative exam no residual dye was noticed
on the posterior pole. Inflammatory signs or other adverse effect were
not observed.
Summary: The vital dye trypan blue may be a valuable tool macular
surgery for avoiding iatrogenic retinal damage. The different staining
effect may express a variable tissue affinity. Further studies to the
biocompatibility of the dye with the retinal tissue seem mandatory.