An evaluation of two heavier-than-water internal limiting membrane-specific dyes during macular hole surgery

Steel, David; Karimi, Ayesha; White, Kathryn

doi:10.1007/s00417-015-3193-x

Cited by 14 publications

(20 citation statements)

References 24 publications

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“…We have previously also not found any correlation between the extent of retinal and vitreous side material in macular hole's cases perhaps relating to the lesser degrees of ERM (Steel et al. ).…”

Section: Discussionmentioning

confidence: 67%

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The relationship between a dissociated optic nerve fibre layer appearance after macular hole surgery and Muller cell debris on peeled internal limiting membrane

Steel

Dinah

White

et al. 2016

Acta Ophthalmologica

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Section: Discussionmentioning

confidence: 67%

“…Different dyes have been shown to be associated with differing degrees of retinal side material on the ILM (Steel et al. ). We therefore used the same dye with the same duration of application time in all cases.…”

Section: Discussionmentioning

confidence: 99%

The relationship between a dissociated optic nerve fibre layer appearance after macular hole surgery and Muller cell debris on peeled internal limiting membrane

Steel

Dinah

White

et al. 2016

Acta Ophthalmologica

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“…Our study was not connected with regulatory approval in any way. We investigated the dye for its staining properties and the induced cleavage plane of the internal limiting membrane (ILM) from the retina [1]. We also reported visual acuity outcomes which were no different from those found using Brilliant Blue G within the limitations of our experimental design.…”

mentioning

confidence: 83%

Letter in response to letter: intraocular use of acid violet 17 at a concentration of 1.5 mg/ml is not safe

Steel

2017

Graefes Arch Clin Exp Ophthalmol

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Dear Editor, We thank Professor Gerding for his letter in response to our publication. We would like to point out that the study was performed and accepted for publication after the dye had been approved for human use and before it was withdrawn from the market. Our study was not connected with regulatory approval in any way. We investigated the dye for its staining properties and the induced cleavage plane of the internal limiting membrane (ILM) from the retina [1]. We also reported visual acuity outcomes which were no different from those found using Brilliant Blue G within the limitations of our experimental design. In the patients we treated, we did not observe any dye-related toxicity based on either vision, neurosensory retinal changes or retinal pigment epithelial alterations. Our ILM cleavage plane findings were also reassuring in this respect. We were concerned to hear of Professor Gerding's paper and, like all other responsible surgeons, stopped using the dye as soon as it was withdrawn from the market.We agree with all the points made regarding the preclinical studies. Indeed, in our article we noted that inner retinal toxicity had been found at doses exceeding 0.125 mg/ml in bovine eyes [2] and that the marketed preparation had a concentration of 1.5 mg/ml. We hypothesised that our methodology of a short (10 s) contact time and the added mannitol may explain the lack of toxicity we observed. Other possibilities-which we acknowledge are pure postulation-include a short light exposure time and low illumination levels during peeling. We also avoided repeat staining after ILM peeling ('double staining'). We were careful in the manuscript to explain our exact methodology of dye application, which avoids the jetting of dye onto the macular area and hole itself, and which as the correspondent observes may also have an effect on the occurrence of toxicity.We agree that a more vigorous approval process for dyes used during vitrectomy surgery should be considered by the regulatory bodies. This should include representative in vivo animal models using the concentrations and formulation as used in the marketed product. The tests should include the effects of light exposure during and after dye exposure, with direct dye-ILM contact without intervening vitreous for clinically realistic time periods. They should also evaluate the contact of dyes after ILM peeling on the exposed retinal nerve fibre layer, as double staining to check that all ILM has been peeled has been commonly described in surgical papers.

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“…[25,26] More recently, acid violet 17 was introduced. It is an ILM-specific dye, allowing satisfying contrast with acceptable safety profile, [23,27] but it is not yet commercially available until toxicity information is further investigated. [18] Heavier than water dyes are prepared by mixing the above compounds with either deuterium oxide, polyethylene glycol, or mannitol.…”

Section: Ilm Dyeingmentioning

confidence: 99%

Idiopathic macular holes – A review of current management strategies

Sela¹,

Hadayer²,

Zahavi³

2019

cleverjournal

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Description of the Condition Macular holes (MHs) are retinal defects which involve the center of the anatomical fovea. [1,2] Severity may range from asymptomatic incidentally discovered MHs, to advanced vision-threatening ones. [2,3] MHs are often described according to the extent of retinal layers involvement. Full-thickness MHs (FTMHs) encompass all the layers of the retina from the internal limiting membrane (ILM) to the retinal pigmented epithelium (RPE) [Figure 1]. [2] Partialthickness MHs, also termed lamellar holes, involve only the inner retinal layers, while the photoreceptors layer may remain intact [Figure 2]. [2,3] Although the majority of cases are idiopathic (>85%), MHs may also be secondary to various conditions, among the most common of which are high myopia and ocular trauma. [2,4,5] Kumawat et al. described in detail other infrequent causes of secondary MHs. [5] Epidemiology The reported prevalence of idiopathic MHs (IMHs) in the general population ranges between 0.02% and 0.33%. [1,4] IMHs are more common in women (approximately 70% of cases) and usually appear in the 6 th and 7 th decades of life. [1,4,6] For patients with an idiopathic FTMH in one eye, the risk for developing an MH in the fellow eye is 10-20%. [1,7] Pathophysiology IMHs are the sequelae of vitreomacular adhesion (VMA) and traction (VMT). [2] The vitreous is a clear gel-like structure enveloped by a hyaloid membrane (the vitreous cortex), the posterior part of which is attached to the ILM of the retina. With aging, the vitreous body liquefies, shrinks, and gradually detaches from the retina, starting at the posterior pole. Physiologically, the vitreous will continue to detach from the retina and eventually remain firmly attached to the retina only at the vitreous base, straddling the ora serrata. In most cases, this process results in no retinal damage. [2,8,9] However, incomplete or abnormal detachment may result in pathologic VMA and VMT, which can distort the foveal contour and result in MH formation [Figure 3]. [8] The traction forces affect the foveola and might impair central vision, causing distorted vision or decreased visual acuity (VA). [2,5,10]

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An evaluation of two heavier-than-water internal limiting membrane-specific dyes during macular hole surgery

Abstract: Both stains were successfully used to peel the ILM with comparable outcomes. AV17-M resulted in less retinal debris than BBG-P, suggesting an altered and potentially beneficial ILM cleavage plane from the retina but with lowered staining contrast than BBG-PEG.

Cited by 14 publications

References 24 publications

The relationship between a dissociated optic nerve fibre layer appearance after macular hole surgery and Muller cell debris on peeled internal limiting membrane

The relationship between a dissociated optic nerve fibre layer appearance after macular hole surgery and Muller cell debris on peeled internal limiting membrane

Letter in response to letter: intraocular use of acid violet 17 at a concentration of 1.5 mg/ml is not safe

Idiopathic macular holes – A review of current management strategies

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