The Combination of Trypan Blue and Brilliant Blue G-Assisted Vitrectomy for Macular Pucker: Histopathological Findings

Abstract

Purpose: To report on the combined use of trypan blue (TB) and brilliant blue G (BBG) for staining the epiretinal membrane (ERM) and internal limiting membrane (ILM) during vitrectomy and to describe the histopathological findings. Methods: 10 surgical specimens were removed from 10 eyes with macular pucker during vitrectomy using a commercially available combination of TB and BBG for ERM and ILM staining and peeling. Specimens were evaluated using light and transmission electron microscopy. Results: In all cases the combination of TB and BBG was useful for identifying and delineating ERM and ILM. No complications related to the use of the dye were observed during or after surgery. Glial cells were present in all specimens. Hyalocytes were observed in 6 cases and myofibroblasts in 3 of them. In 7 cases native vitreous collagen fibrils were found on the ILM, while in 5 specimens newly formed collagen was present. No clinical evidence of toxicity was observed during the 3-month follow-up. Conclusion: The combined use of TB and BBG appeared to be very useful intraoperatively to improve the visualization of ERM and ILM, thus facilitating their complete removal. Anatomical and histopathological findings demonstrated the safety and the efficacy of this vital dye.

Multimodal imaging of a vascularized idiopathic epiretinal membrane

“…Former histological studies described vascular endothelial growth factor to play a role in the growth of new vessels in previously existing fibrovascular membranes with no evidence of VEGF immunoreactivity in avascular membranes as described by Frank et al, 7 in addition a new research described the histopathological findings of patients with diagnosis of macular pucker did not show evidence of VEGF. 8 However, other studies described the presence of VEGF and FGF (fibroblast growth factor) in both vascular and avascular epiretinal membranes 1,9,10 wherein angiogenic factors were expressed in proliferative diabetic retinopathy and in relatively avascular proliferative vitreoretinopathy membranes and macular pucker as well. This suggests that even avascular membranes could develop abnormal vascularization and raises a question regarding the development of neovascularization secondary to angiogenic factors.…”

Geographic variations in idiopathic epiretinal membranes in China

“…Consequently, we had to use income data from the National Bureau of Statistics of China as a measure of SES. Lastly, the study of intraoperative dyeing usage for staining ILM was not included in this questionnaire due to the availability problem of dyes in mainland China (18,19). In conclusion, the monthly admissions and preoperative and postoperative care of ERM patients varied significantly across different regions in China.…”